NPIMap

Individual provider Active NPI

Benjamin Head, MD

  • Family Medicine Physician
  • Cordova, AK
National Provider Identifier
1962898080
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
139968 Issued in AK
Practice address
705 2ND Street
Cordova, AK 99574-2290
Phone
(907) 424-3622
Fax
(907) 424-3275
NPI assigned
Apr 15, 2015
Last updated
Sep 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 139968 AK Primary

Addresses

Primary practice location

705 2ND Street
Cordova, AK 99574-2290

Mailing address

705 2ND Street
Cordova, AK 99574-2290
Phone (907) 424-3622

Other practice location 1

711 Onyx St
Kemmerer, WY 83101
Phone (307) 877-4401

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address BHEAD@direct.eyak-nsn.gov Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210525000299 TX Practitioner - Family Practice 0042515702 Reassigns benefits to 1 organization
I20221118001759 AK Practitioner - Family Practice 0042515702 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cordova Community Medical CenterGroup PAC ID 1759275902, 17 clinicians
Native Village of EyakGroup PAC ID 1052220878, 8 clinicians

Practice addresses (Care Compare)

602 Chase Ave
Cordova, AK 99574-0559
Phone (907) 424-8000

705 2ND St
Native Village of Eyak Ilanka Com
Cordova, AK 99574-2290
Phone (907) 424-3622

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
139968AKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Native Village of Eyak CurrentSince May 3, 2021 Accepting new patients
Cordova Community Medical Center CurrentSince Oct 1, 2022 Accepting new patients
Native Village of Eyak CurrentSince May 3, 2021 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: bhead@direct.eyak-nsn.gov
  • FHIR API: https://fhir-usa.unify.chbase.com/org/cordova-527880fe

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1429056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1962898080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 2ND STREET",
            "city": "CORDOVA",
            "state": "AK",
            "postal_code": "995742290",
            "telephone_number": "907-424-3622",
            "fax_number": "907-424-3275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 2ND STREET",
            "city": "CORDOVA",
            "state": "AK",
            "postal_code": "995742290",
            "telephone_number": "907-424-3622",
            "fax_number": "907-424-3275"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "711 Onyx St",
            "address_purpose": "LOCATION",
            "city": "Kemmerer",
            "state": "WY",
            "postal_code": "83101",
            "country_code": "US",
            "telephone_number": "307-877-4401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEAD",
        "first_name": "BENJAMIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-15",
        "last_updated": "2021-09-01",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "139968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "BHEAD@direct.eyak-nsn.gov",
            "affiliation": "N",
            "endpointDescription": "Ilanka Community Health Center",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "705 2nd Street",
            "city": "Cordova",
            "state": "AK",
            "country_code": "US",
            "postal_code": "995742290",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cordova, AK

Sources for this page

Verify at the official NPI Registry.