Individual provider Active NPI

Benjamin Donaldson, PA-C

  • Physician Assistant
  • Leland, NC
National Provider Identifier
1679835276
Registry record updated Sep 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2050 Mercantile Dr
Leland, NC 28451-4053
Phone
(910) 371-2500
NPI assigned
Jun 11, 2012
Last updated
Sep 5, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary
Medical Physician Assistant 363AM0700X 0010-03577 NC

Addresses

Primary practice location

2050 Mercantile Dr
Leland, NC 28451-4053

Mailing address

807 W End Blvd
Apt C9
Winston Salem, NC 27101-2427

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20120716000482 NC Practitioner - Physician Assistant 3274799408 Reassigns benefits to 2 organizations
I20220621002005 SC Practitioner - Physician Assistant 3274799408 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Trinity Wellness Center of Wilmington IncGroup PAC ID 6002843752, 14 clinicians

Practice addresses (Care Compare)

1000 Corporate Dr
Suite 301
Hillsborough, NC 27278-8551
Phone (910) 343-8424

1907 S 17TH St
Suite 1
Wilmington, NC 28401-6626

2528 Castle Hayne Rd
Suite 5
Wilmington, NC 28401-2693
Phone 91034384242

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-03577NCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Holly Ridge Chiropractic & Auto Injury PastSince Aug 1, 2015 Accepting new patients

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1679835276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 W END BLVD",
            "address_2": "APT C9",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271012427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 MERCANTILE DR",
            "city": "LELAND",
            "state": "NC",
            "postal_code": "284514053",
            "telephone_number": "910-371-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONALDSON",
        "first_name": "BENJAMIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-11",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-03577",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leland, NC

Sources for this page

Verify at the official NPI Registry.