Benjamin Michael Anderson, PSY.D.
Individual provider Active NPI Psychologist · Newport, KY
NPI 1730306754 · NPPES record last updated Mar 8, 2019
Key facts
- NPI
- 1730306754
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 128177 (KY)
- Practice address
- 1400 Grand Avenue
Newport, KY 41071 - Phone
- (859) 301-5901
- Fax
- (859) 301-5940
- NPI assigned
- Apr 19, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Summit Medical Group Inc
Practice addresses (Care Compare)
1400 Grand Ave
Newport, KY 41071-2570
Phone (859) 912-7193
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.01 of 100
- Quality
- 86.02
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171212001190 | KY | Practitioner - Clinical Psychologist | 1951669332 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71007260 | IL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Medical Group, Inc | Psychologist | Current |
Accepting new patients |
| Summit Medical Group, Inc. | Current |
Accepting new patients |
Locations
1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700
1400 Grand Ave
Newport, KY 41071
Phone (859) 905-3070
300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217
Interoperability endpoints
- banderson215478@direct-prd.stelizabeth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 71007260 | IL | |
| Psychologist | 103T00000X | 128177 | KY | Yes |
Addresses
Primary practice location
1400 Grand Avenue
Newport, KY 41071
Mailing address
PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 301-5901
Other practice location 1
1811 W. Diehl Rd.
Suite 700
Naperville, IL 60563
Phone (630) 983-0600 ext. 16
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| K237430 | Other | KY | KY MEDICARE |
| 7100501510 | Medicaid | KY |
Other providers in Newport, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.