Benjamin Clark Stovall, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4467 Issued in GA

Practice address

2003 Alice St Ste a
Waycross, GA 31501-6209

Phone

(912) 285-0053

NPI assigned

Oct 11, 2019

Last updated

Oct 11, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sports Medicine and Rehab Therapy, LLCGroup PAC ID 1658415054, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Sports Medicine and Rehab Therapy, LLC

  dba SMaRT Physical Therapy

  • Physical Medicine & Rehabilitation Physician
  • Waycross, GA
  • NPI 1396079224
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1570752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570752000000",
    "number": "1730721655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5210 MEADOW WOOD RD",
            "city": "BLACKSHEAR",
            "state": "GA",
            "postal_code": "315164473",
            "telephone_number": "912-281-2619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 ALICE ST STE A",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315016209",
            "telephone_number": "912-285-0053"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2003 Alice St Ste A",
            "address_purpose": "LOCATION",
            "city": "Waycross",
            "state": "GA",
            "postal_code": "315016209",
            "country_code": "US",
            "telephone_number": "912-285-0053",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOVALL",
        "first_name": "BENJAMIN",
        "middle_name": "CLARK",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-11",
        "last_updated": "2019-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "4467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Herbert Stevenot Sr., OD
• Lauren Stevens, RN
• Heather Leigh Stewart
• Lashunda Nicole Stone, NP-C
• Shad Ashton Stormant
• Christie Melissa Strickland, RN-NP
• Frankie Strickland, CCC-SLP
• Taylor Marie Strickland
• Ansley Stroud Sellers, SLP
• Jewell Studstill, RN

• Physical Therapist in Waycross, GA
• Providers in Waycross, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.