Individual provider Active NPI

Benjamin W Speicher, PA-C

  • Physician Assistant
  • Redding, CA
National Provider Identifier
1790204824
Registry record updated Apr 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
54859 Issued in CA
Practice address
2175 Rosaline Ave
Redding, CA 96001-2549
Phone
(530) 225-6000
NPI assigned
Sep 9, 2017
Last updated
Apr 26, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2021

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 54859 CA Primary

Addresses

Primary practice location

2175 Rosaline Ave
Redding, CA 96001-2549

Mailing address

310 Sunnyview LN
Kalispell, MT 59901-3129
Phone (406) 752-5111

Other practice location 1

310 Sunnyview Ln
Kalispell, MT 59901-3129
Phone (406) 752-5111

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krmcmedicalrecords@krhdirect.org Kalispell Regional Medical Center Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
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
I20210707002074 MT Practitioner - Physician Assistant 9931474186 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Kalispell Regional Medical Center, Inc CurrentSince Jul 1, 2021 Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Glacier Regional Pathology, LTD. Current Accepting new patients
Kalispell Regional Medical Center Inc CurrentSince Jul 1, 2021 Accepting new patients

Locations

310 Sunnyview Ln
Kalispell, MT 59901
Phone (406) 751-5310

350 Heritage Way
Ste 2100
Kalispell, MT 59901
Phone (406) 257-8992

Interoperability endpoints

  • Direct secure messaging: krmcmedicalrecords@krhdirect.org

Organizations & group practices 4

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": "1504915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619395200000",
    "number": "1790204824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 SUNNYVIEW LN",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013129",
            "telephone_number": "406-752-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2175 ROSALINE AVE",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960012549",
            "telephone_number": "530-225-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "310 Sunnyview Ln",
            "address_purpose": "LOCATION",
            "city": "Kalispell",
            "state": "MT",
            "postal_code": "599013129",
            "country_code": "US",
            "telephone_number": "406-752-5111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPEICHER",
        "first_name": "BENJAMIN",
        "middle_name": "W",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-09",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center Inc",
            "address_1": "310 Sunnyview Ln",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599013129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Redding, CA

Sources for this page

Verify at the official NPI Registry.