Individual provider Active NPI

Benjamin Hodges, PA-C

  • Physician Assistant
  • Fort Atkinson, WI
National Provider Identifier
1790266971
Registry record updated Oct 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5474-23 Issued in WI
Practice address
1504 Madison Ave
Fort Atkinson, WI 53538-3100
Phone
(920) 563-7888
NPI assigned
Aug 24, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.006721 IL
Medical Physician Assistant 363AM0700X 085.006721 IL
Surgical Physician Assistant 363AS0400X 085.006721 IL
Physician Assistant 363A00000X 5474-23 WI Primary

Addresses

Primary practice location

1504 Madison Ave
Fort Atkinson, WI 53538-3100

Mailing address

PO Box 249
Fort Atkinson, WI 53538-0249
Phone (920) 563-4466

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20210727002900 WI Practitioner - Physician Assistant 6608110077 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fort Healthcare IncGroup PAC ID 0840189718, 159 clinicians

Practice addresses (Care Compare)

1504 Madison Ave
Fort Atkinson, WI 53538-3100
Phone (920) 563-7888

1520 Madison Ave
Fort Atkinson, WI 53538-3100
Phone (920) 563-5500

611 E Sherman Ave
Fort Atkinson, WI 53538-1960
Phone (920) 568-5000

611 Sherman Ave E
Fort Atkinson, WI 53538-1960
Phone (920) 568-6596

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085.006721ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Healthcare, Inc. CurrentSince Jul 1, 2021 Accepting new patients
Fort Healthcare Inc Past Accepting new patients

Locations

1504 Madison Ave
Fort Atkinson, WI 53538
Phone (920) 563-7888

611 Sherman Ave E
Fort Atkinson, WI 53538
Phone (920) 563-6667

Interoperability endpoints

  • Direct secure messaging: benjamin.hodges@direct.forthc.com

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 2

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": "1535068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665100800000",
    "number": "1790266971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 249",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535380249",
            "telephone_number": "920-563-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 MADISON AVE",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535383100",
            "telephone_number": "920-563-7888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HODGES",
        "first_name": "BENJAMIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-24",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.006721",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085.006721",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085.006721",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "5474-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Atkinson, WI

Sources for this page

Verify at the official NPI Registry.