Individual provider Active NPI

Benjamin Ryan Staley

  • Physician Assistant
  • Wilmington, NC
National Provider Identifier
1972220168
Registry record updated Dec 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-15849 Issued in NC
Practice address
1415 Physicians Dr
Wilmington, NC 28401-7338
Phone
(910) 662-9500
NPI assigned
Oct 27, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Physician Assistant 363A00000X 0010-15849 NC Primary

Addresses

Primary practice location

1415 Physicians Dr
Wilmington, NC 28401-7338

Mailing address

PO Box 936857
Atlanta, GA 31193-6857

Other practice location 1

2553 31st St Apt E104
Denver, CO 80216-4824
Phone (240) 446-3700

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251223000708 NC Practitioner - Physician Assistant 4789058405 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group Coastal Region LLCGroup PAC ID 2860809936, 577 clinicians

Practice addresses (Care Compare)

1415 Physicians Dr
Wilmington, NC 28401-7338
Phone (910) 662-9500

Hospital & facility affiliations

  • University of MD Baltimore Washington Medical Center Hospital, Glen Burnie, MD, CCN 210043
  • Novant Health New Hanover Regional Medical Center Hospital, Wilmington, NC, CCN 340141

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-15849NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group Coastal Region, LLC CurrentSince Dec 5, 2025 Accepting new patients
NMG Health Services LLC CurrentSince Dec 5, 2025 Accepting new patients
New Hanover Medical Group PA Past Accepting new patients

Locations

800 Jefferson St
Ste 112
Whiteville, NC 28472
Phone (910) 642-8164

1415 Physicians Dr
Wilmington, NC 28401
Phone (910) 251-3766

1500 Physicians Dr
Wilmington, NC 28401
Phone (910) 736-6332

Interoperability endpoints

  • Direct secure messaging: bstaley1016760@direct.umm.edu

Organizations & group practices 4

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": "1666828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766707200000",
    "number": "1972220168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936857",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 PHYSICIANS DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017338",
            "telephone_number": "910-662-9500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2553 31st St Apt E104",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802164824",
            "country_code": "US",
            "telephone_number": "240-446-3700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STALEY",
        "first_name": "BENJAMIN",
        "middle_name": "RYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-27",
        "last_updated": "2025-12-26",
        "certification_date": "2025-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-15849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.