Individual provider Active NPI

Benjamin Gregory Crisp, MD

  • Surgery Physician
  • Raleigh, NC
National Provider Identifier
1790216505
Registry record updated Sep 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2023-02063 Issued in NC
Practice address
4207 Lake Boone TRL Ste 210
Raleigh, NC 27607-6685
Phone
(919) 784-7874
Fax
(919) 784-2708
NPI assigned
Mar 23, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 332669 LA
Surgery Physician 208600000X 2023-02063 NC Primary

Addresses

Primary practice location

4207 Lake Boone TRL Ste 210
Raleigh, NC 27607-6685

Mailing address

4207 Lake Boone TRL Ste 210
Raleigh, NC 27607-6685
Phone (919) 784-7874

Other practice location 1

1 akron general ave
akron, OH 44307-2432
Phone (330) 344-6000

Other practice location 2

1430 Tulane Ave # 8622
New Orleans, LA 70112-2632
Phone (504) 988-2317

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bcrisp102608@direct.UNC.nchie.net Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231010002551 NC Practitioner - General Surgery 7719259738 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of North Carolina at Chapel Hill School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Carolina MG LLCGroup PAC ID 1951828847, 723 clinicians

Practice addresses (Care Compare)

4207 Lake Boone TRL
Raleigh, NC 27607-6684
Phone (919) 784-7874

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Carolina MG, LLC Surgery CurrentSince Jun 1, 2025 Accepting new patients
Rex Hospital Inc Past Accepting new patients

Locations

850 S Main St
Holly Springs, NC 27540
Phone (919) 784-7093

5221 Paramount Pkwy
Ste 420
Morrisville, NC 27560
Phone (984) 215-6533

4420 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-3034

4207 Lake Boone Trl
Ste 210
Raleigh, NC 27607
Phone (919) 784-2822

11200 Governor Manly Way
Ste 208
Raleigh, NC 27614

4207 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 780-0815

4420 Lake Boone Trl
Ste 100
Raleigh, NC 27607
Phone (984) 215-6950

Interoperability endpoints

  • Direct secure messaging: bcrisp102608@direct.unc.nchie.net

Organizations & group practices 2

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 1

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": "1490227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1790216505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4207 LAKE BOONE TRL STE 210",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276076685",
            "telephone_number": "919-784-7874",
            "fax_number": "919-784-2708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4207 LAKE BOONE TRL STE 210",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276076685",
            "telephone_number": "919-784-7874",
            "fax_number": "919-784-2708"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 akron general ave",
            "address_purpose": "LOCATION",
            "city": "akron",
            "state": "OH",
            "postal_code": "443072432",
            "country_code": "US",
            "telephone_number": "330-344-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1430 Tulane Ave # 8622",
            "address_purpose": "LOCATION",
            "city": "New Orleans",
            "state": "LA",
            "postal_code": "701122632",
            "country_code": "US",
            "telephone_number": "504-988-2317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRISP",
        "first_name": "BENJAMIN",
        "middle_name": "GREGORY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-23",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "LA",
            "license": "332669",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "2023-02063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bcrisp102608@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "4207 Lake Boone Trl Ste 210",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276076685",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.