Individual provider Active NPI

Benjamin Lawlor, PA

  • Physician Assistant
  • Redford, MI
National Provider Identifier
1679163075
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
AMD-1274 Issued in HI
Practice address
14671 Telegraph Rd
Redford, MI 48239-3300
Phone
(313) 948-3030
NPI assigned
Jan 20, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X AMD-1274 HI Primary

Addresses

Primary practice location

14671 Telegraph Rd
Redford, MI 48239-3300

Mailing address

14671 Telegraph Rd
Redford, MI 48239-3300
Phone (734) 771-8504

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230929000716 HI Practitioner - Physician Assistant 1850705260 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Nova Southeastern College of Osteo Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kau HospitalGroup PAC ID 7416945548, 138 clinicians

Practice addresses (Care Compare)

1 Kamani St
Pahala, HI 96777
Phone (808) 932-4370

1190 Waianuenue Ave
Hilo, HI 96720-2089
Phone (808) 932-3730

PO Box
Pahala, HI 96777

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kau Hospital CurrentSince Aug 1, 2023 Accepting new patients
Kau Hospital CurrentSince Aug 1, 2023 Accepting new patients
Kau Hospital Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1679163075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14671 TELEGRAPH RD",
            "city": "REDFORD",
            "state": "MI",
            "postal_code": "482393300",
            "telephone_number": "734-771-8504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14671 TELEGRAPH RD",
            "city": "REDFORD",
            "state": "MI",
            "postal_code": "482393300",
            "telephone_number": "313-948-3030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWLOR",
        "first_name": "BENJAMIN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-20",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "HI",
            "license": "AMD-1274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redford, MI

Sources for this page

Verify at the official NPI Registry.