NPIMap

Individual provider Active NPI

Benjamin Grant Marshall, M.D.

  • Family Medicine Physician
  • Titusville, FL
National Provider Identifier
1922369859
Registry record updated Jan 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
TRN 17849 Issued in FL
Practice address
1785 Garden St
Titusville, FL 32796-3221
Phone
(321) 269-9612
Fax
(321) 269-8433
NPI assigned
Jun 7, 2012
Last updated
Jan 4, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 4, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD208003 LA
Family Medicine Physician 207Q00000X TRN 17849 FL Primary

Addresses

Primary practice location

1785 Garden St
Titusville, FL 32796-3221

Mailing address

1785 Garden St
Titusville, FL 32796-3221
Phone (213) 269-9612

Other identifiers 2

IdentifierTypeStateIssuer
ME118384OtherFLMEDICAL LICENSE
LS576OtherFLPTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20191008003594 FL Practitioner - Family Practice 1456661107 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Eastern Virginia Medical School, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mission Family Medicine LLCGroup PAC ID 2769869593, 5 clinicians

Practice addresses (Care Compare)

1785 Garden St
Titusville, FL 32796-3221
Phone (321) 269-9612

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TRN 17849FLMDFamily Medicine Physician
MD208003LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
My Vital View, LLC CurrentSince Mar 1, 2022 Accepting new patients
Mission Family Medicine LLC Family Medicine CurrentSince Jul 1, 2022 Accepting new patients
Privia Medical Group Florida, LLC CurrentSince Jan 1, 2025 Accepting new patients

Locations

140 6th Ave
Indialantic, FL 32903
Phone (321) 312-3501

2194 Highway A1A
Ste 107
Indian Harbour Beach, FL 32937
Phone (321) 241-4551

989 Sebastian Blvd
Unit 3
Sebastian, FL 32958
Phone (727) 617-1777

1785 Garden St
Titusville, FL 32796
Phone (321) 269-9612

Interoperability endpoints

  • Direct secure messaging: benjamin.marshall.1@24331.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/24331/brand/1/csg/1/fhir/r4

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1339027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1922369859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1785 GARDEN ST",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327963221",
            "telephone_number": "213-269-9612",
            "fax_number": "321-268-8433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1785 GARDEN ST",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327963221",
            "telephone_number": "321-269-9612",
            "fax_number": "321-269-8433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "BENJAMIN",
        "middle_name": "GRANT",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-07",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD208003",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "TRN 17849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME118384",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "LS576",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Titusville, FL

Sources for this page

Verify at the official NPI Registry.