NPIMap

Individual provider Active NPI

Benjamin C Smith, MD

  • Diagnostic Radiology Physician
  • Detroit Lakes, MN
National Provider Identifier
1831352947
Registry record updated Dec 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
52376 Issued in MN
Practice address
1027 Washington Ave
Detroit Lakes, MN 56501-3409
Phone
(218) 847-5611
Fax
(218) 847-0881
NPI assigned
Jul 8, 2008
Last updated
Dec 23, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 104475 MN
Diagnostic Radiology Physician 2085R0202X 52376 MN Primary

Addresses

Primary practice location

1027 Washington Ave
Detroit Lakes, MN 56501-3409

Mailing address

1027 Washington Ave
Detroit Lakes, MN 56501-3409
Phone (218) 847-5611

Other identifiers 2

IdentifierTypeStateIssuer
1831352947MedicaidMN
P01206393OtherMNRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20090817000064 MN Practitioner - Diagnostic Radiology 6800940461 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Minnesota Medical School, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Regional Health CenterGroup PAC ID 2062326820, 190 clinicians

Practice addresses (Care Compare)

1027 Washington Ave
Detroit Lakes, MN 56501-3409
Phone (218) 844-2300

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary's Regional Health Center CurrentSince Jul 1, 2014 Accepting new patients
St. Marys Regional Health Center Current Accepting new patients
St Mary's Regional Health Center CurrentSince Jul 1, 2014 Accepting new patients
Mayo Clinic Past Accepting new patients
Innovis Health LLC PastSince May 17, 2022 Accepting new patients

Locations

1027 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 844-2300

Ownership & related parties

All facility ownership & control disclosures 25

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Essentia Health St Mary's Detroit LakesDetroit Lakes, MN, CCN 240101 Hospital Corporate Director May 17, 2022
Essentia Health FosstonFosston, MN, CCN 241357 Hospital Corporate Director May 17, 2022
Essentia Health AdaAda, MN, CCN 241313 Hospital Corporate Director May 17, 2022
Essentia Health FosstonFosston, MN, CCN 24Z357 Hospital Corporate Director May 17, 2022
Essentia Health Holy Trinity HospitalGraceville, MN, CCN 241321 Hospital Corporate Director May 17, 2022
Essentia Health Holy Trinity HospitalGraceville, MN, CCN 24Z321 Hospital Corporate Director May 17, 2022
Innovis Health LLCFargo, ND, CCN 350070 Hospital Corporate Director May 17, 2022
Essentia Health AdaAda, MN, CCN 24Z313 Hospital Corporate Director May 17, 2022
Essentia Health - Oak CrossingDetroit Lakes, MN, CCN 245212 Skilled nursing facility Corporate Director May 17, 2022
Essentia Health Grace HomeGraceville, MN, CCN 245579B Skilled nursing facility Corporate Director May 17, 2022
Essentia Health First Care Living CenterFosston, MN, CCN 245512 Skilled nursing facility Corporate Director May 17, 2022
Essentia Health Home Care WestDetroit Lakes, MN, CCN 248052 Home health agency Corporate Director May 17, 2022
Essentia Health Home Care GracevilleGraceville, MN, CCN 248045 Home health agency Corporate Director May 17, 2022
Essentia Health Hospice WestFosston, MN, CCN 241564 Hospice Corporate Director May 17, 2022
Essentia Health Ada ClinicAda, MN, CCN 243416 Rural health clinic Corporate Director May 17, 2022
Essentia Health Graceville ClinicGraceville, MN, CCN 243997B Rural health clinic Corporate Director May 17, 2022
Essentia Health Oklee ClinicOklee, MN, CCN 243464 Rural health clinic Corporate Director May 17, 2022
Essentia Health Bagley ClinicBagley, MN, CCN 243461 Rural health clinic Corporate Director May 17, 2022
Essentia Health St Mary's Mahnomen ClinicMahnomen, MN, CCN 243468 Rural health clinic Corporate Director May 17, 2022
Essentia Health St Mary's Pelican Rapids ClinicPelican Rapids, MN, CCN 243472 Rural health clinic Corporate Director May 17, 2022
Essentia Health Park Rapids ClinicPark Rapids, MN, CCN 243471 Rural health clinic Corporate Director May 17, 2022
Essentia Health Menahga ClinicMenahga, MN, CCN 243475 Rural health clinic Corporate Director May 17, 2022
Essentia Health Walker ClinicWalker, MN, CCN 243474 Rural health clinic Corporate Director May 17, 2022
Essentia Health St. Mary's Frazee ClinicFrazee, MN, CCN 243492 Rural health clinic Corporate Director May 17, 2022
Essentia Health Park Rapids Hwy 34 ClinicPark Rapids, MN, CCN 243493 Rural health clinic Corporate Director May 17, 2022

Owned or controlled facilities with NPI records 25

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 25

Organizations & group practices 5

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.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450828800000",
    "number": "1831352947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 WASHINGTON AVE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013409",
            "telephone_number": "218-847-5611",
            "fax_number": "218-847-0881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 WASHINGTON AVE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013409",
            "telephone_number": "218-847-5611",
            "fax_number": "218-847-0881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "BENJAMIN",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-08",
        "last_updated": "2015-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "104475",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "52376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831352947",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01206393",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit Lakes, MN

Sources for this page

Verify at the official NPI Registry.