NPIMap

Individual provider Active NPI

Michael Benjamin Doctor, M.D.

  • Emergency Medicine Physician
  • New York, NY
National Provider Identifier
1740625656
Registry record updated Nov 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
283614 Issued in NY
Practice address
1000 10TH Ave
New York, NY 10019-1147
Phone
(212) 523-4000
NPI assigned
May 6, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 17439 NV
Emergency Medicine Physician 207P00000X 283614 NY Primary

Addresses

Primary practice location

1000 10TH Ave
New York, NY 10019-1147

Mailing address

1000 10TH Ave
New York, NY 10019-1147
Phone (212) 523-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171229001943 NV Practitioner - Emergency Medicine 0547550212 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shadow Emergency Physicians PLLCGroup PAC ID 2860667375, 105 clinicians

Practice addresses (Care Compare)

620 Shadow LN
Las Vegas, NV 89106-4119
Phone (954) 939-5000

Hospital & facility affiliations

  • Valley Hospital Medical Center Hospital, Las Vegas, NV, CCN 290021
  • Summerlin Hospital Medical Center Hospital, Las Vegas, NV, CCN 290041
  • Spring Valley Hospital Medical Center Hospital, Las Vegas, NV, CCN 290046
  • Centennial Hills Hospital Medical Center Hospital, Las Vegas, NV, CCN 290054

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
17439NVMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Shadow Emergency Physicians PLLC Emergency Medicine CurrentSince Nov 1, 2017 Accepting new patients
Shadow Emergency Physicians PLLC Emergency Medicine CurrentSince Nov 1, 2017 Accepting new patients
Valley Hospital Medical Center Past Accepting new patients

Locations

620 Shadow Ln
Las Vegas, NV 89106
Phone (702) 388-4506

657 N Town Center Dr
Las Vegas, NV 89144
Phone (702) 233-7571

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 12

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": "1367798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509667200000",
    "number": "1740625656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 10TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191147",
            "telephone_number": "212-523-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 10TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191147",
            "telephone_number": "212-523-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOCTOR",
        "first_name": "MICHAEL",
        "middle_name": "BENJAMIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-06",
        "last_updated": "2017-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NV",
            "license": "17439",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "283614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.