NPIMap

Individual provider Active NPI

Benjamen Russell Shrewsberry, BCBA

  • Behavior Analyst
  • Wake Forest, NC
National Provider Identifier
1992241921
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
6578 Issued in TX
Practice address
1936 Heritage Branch Rd
Wake Forest, NC 27587-7061
Phone
(984) 326-7227
NPI assigned
Jan 14, 2017
Last updated
Feb 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 139 NC
Behavior Analyst 103K00000X 1-18-30603 VA
Behavior Analyst 103K00000X 1-18-30603 CO
Behavior Analyst 103K00000X 6578 TX Primary

Addresses

Primary practice location

1936 Heritage Branch Rd
Wake Forest, NC 27587-7061

Mailing address

1936 Heritage Branch Rd
Wake Forest, NC 27587-7061
Phone (984) 326-7227

Other practice location 1

111 Mackenan Dr
Cary, NC 27511
Phone (919) 371-2848

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Carolina Center for ABA & Autism Treatment Past Accepting new patients
Action Behavior Centers LLC Behavior Analyst PastSince Feb 4, 2024 Accepting new patients
Action Behavior Centers Therapy LLC Behavior Analyst PastSince Feb 4, 2024 Accepting new patients
Action Behavior Centers, LLC Behavior Analyst Past Accepting new patients
Carolina Center for Autism Services, LLC Behavior Analyst Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1484352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1992241921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1936 HERITAGE BRANCH RD",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275877061",
            "telephone_number": "984-326-7227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1936 HERITAGE BRANCH RD",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275877061",
            "telephone_number": "984-326-7227"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Mackenan Dr",
            "address_purpose": "LOCATION",
            "city": "Cary",
            "state": "NC",
            "postal_code": "27511",
            "country_code": "US",
            "telephone_number": "919-371-2848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHREWSBERRY",
        "first_name": "BENJAMEN",
        "middle_name": "RUSSELL",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-14",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NC",
            "license": "139",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "VA",
            "license": "1-18-30603",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CO",
            "license": "1-18-30603",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "TX",
            "license": "6578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wake Forest, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.