MR. BENJAMIN DURHAM PA-C NPI 1003006115
Physician Assistant in Thomaston, GA
About MR. BENJAMIN DURHAM PA-C
Benjamin Durham is a primary care provider established in Thomaston, Georgia and his medical specialization is Physician Assistant with more than 16 years of experience. He graduated from Medical College Of Georgia School Of Medicine in 2007. The NPI number of this provider is 1003006115 and was assigned on July 2007. The practitioner's primary taxonomy code is 363A00000X with license number 005084 (GA). The provider is registered as an individual and his NPI record was last updated 3 years ago.
| NPI | 1003006115 |
| Provider Name | MR. BENJAMIN DURHAM PA-C |
| Location Address | 522 N CENTER ST THOMASTON, GA 30286 |
| Location Phone | (706) 646-4371 |
| Mailing Address | PO BOX 370 FORTSON, GA 31808 |
| Gender | Male |
| NPI Entity Type | Individual |
| Medical School Name | MEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE |
| Graduation Year | 2007 |
| Is Sole Proprietor? | No |
| Enumeration Date | 07-26-2007 |
| Last Update Date | 11-20-2020 |
A primary care provider (PCP) like Benjamin Durham sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc Benjamin Durham is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
Benjamin Durham is registered with Medicare and accepts claims assignment, this means the provider accepts Medicare's approved amount for the cost of rendered services as full payment. Participating providers may not charge Medicare beneficiaries more than Medicare's approved amount for their services. Medicare beneficiaries still have to pay a coinsurance or copayment amount for a visit or service. According to Medicare claims data he has hospital affiliations with Jack Hughston Memorial Hospital and Upson Regional Medical Center.
The provider participated in Medicare's Quality Payment Program and the following quality measures were reported: chronic care and preventative care management for empaneled patients, documentation of current medications in the medical record, implementation of medication management practice improvements, measurement and improvement at the practice and panel level, medication reconciliation, patient-specific education, preventive care and screening: body mass index (bmi) screening and follow-up plan, preventive care and screening: tobacco use: screening and cessation intervention, provide patient access, secure messaging, security risk analysis and use of decision support and standardized treatment protocols. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries.
The typical physician office visit costs for Medicare beneficiaries in this area are: $21.36 for a new patient copayment and $17.36 for an established patient copayment.
Primary Taxonomy
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
| Taxonomy Code | 363A00000X |
| Classification | Physician Assistant |
| Type | Physician Assistants & Advanced Practice Nursing Providers |
| License No. | 005084 |
| License State | GA |
| Taxonomy Description | A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
Business Address
522 N CENTER ST
THOMASTON, GA
ZIP 30286
Phone: (706) 646-4371
Fax: (706) 646-4372
Mailing Address
PO BOX 370
FORTSON, GA
ZIP 31808
Fax: (706) 494-3008
Secondary Locations
2300 Manchester Expy # A Suite 101-A
Columbus, GA 31904
(706) 322-2462100 N Macon St
Macon, GA 31210
(478) 200-6970
Location Map
PECOS Enrollment and Medicare Participation Status
What is PECOS?
PECOS is the Medicare Provider, Enrollment, Chain and Ownership System. PECOS is Medicare's enrollment and revalidation system and it is the primary source of information about verified Medicare professionals. A NPI number is necessary to register in PECOS. Providers must enroll in PECOS to avoid denied claims.
| Registered in PECOS? | Yes |
| PECOS PAC ID | 9335223908 |
| PECOS Enrollment ID | I20080221000313, I20110427000583 |
| Accepts Medicare Assignment? | Yes "What does it mean "accepts medicare assignment"? When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts. A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer. |
| Eligible order / refer Part B Clinical Laboratory and Imaging | Yes |
| Eligible order / refer Durable Medical Equipment | Yes |
| Eligible order / refer Home Health Agency (HHA) | Yes |
| Eligible order / refer Power Mobility Devices | Yes |
Physician Office Visit Costs
The provider accepts as payment the Medicare approved amount. Medicare beneficiaries should not be billed for more than the Medicare deductible and coinsurance amounts. Medicare pricing is usually a reference point for private insurance covered patients. The prices below reflect the costs for new and established patients in the 30286 ZIP code area.
| New Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for new patients office visits: 99203 | ||
| Minimum New Patient Pricing | Maximum New Patient Pricing | Typical New Patient Pricing |
| $55.19 | $169.73 | $85.45 |
| Minimum New Patient Copayment | Maximum New Patient Copayment | Typical New Patient Copayment |
| $13.79 | $42.43 | $21.36 |
| Established Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for established patients office visits: 99213 | ||
| Minimum Established Patient Pricing | Maximum Established Patient Pricing | Typical Established Patient Pricing |
| $16.8 | $138.36 | $69.44 |
| Minimum Established Patient Copayment | Maximum Established Patient Copayment | Typical Established Patient Copayment |
| $4.2 | $34.59 | $17.36 |
* The physician office visit costs information is obtained by Medicare's statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Quality Reporting
The following quality measures meet Medicare's statistical reporting standards for the year 2018. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Chronic Care and Preventative Care Management for Empaneled Patients | Yes | N/A |
| Proactively manage chronic and preventive care for empaneled patients that could include one or more of the following: • Provide patients annually with an opportunity for development and/or adjustment of an individualized plan of care as appropriate to age and health status, including health risk appraisal; gender, age and condition-specific preventive care services; and plan of care for chronic conditions; • Use condition-specific pathways for care of chronic conditions (e.g., hypertension, diabetes, depression, asthma and heart failure) with evidence-based protocols to guide treatment to target; such as a CDC-recognized diabetes prevention program; • Use pre-visit planning to optimize preventive care and team management of patients with chronic conditions; • Use panel support tools (registry functionality) to identify services due; • Use predictive analytical models to predict risk, onset and progression of chronic diseases; or • Use reminders and outreach (e.g., phone calls, emails, postcards, patient portals and community health workers where available) to alert and educate patients about services due; and/or routine medication reconciliation. | ||
| Documentation of Current Medications in the Medical Record | 30% | 454 |
| Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration | ||
| Implementation of medication management practice improvements | Yes | N/A |
| Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews. | ||
| Measurement and Improvement at the Practice and Panel Level | Yes | N/A |
| Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level. | ||
| Medication Reconciliation | 86% | 72 |
| The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician. | ||
| Patient-Specific Education | 79% | 434 |
| The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician. | ||
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | 19% | 355 |
| Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2 | ||
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 85% | 33 |
| Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user | ||
| Provide Patient Access | 99% | 434 |
| At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information. | ||
| Secure Messaging | 1% | 434 |
| For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period. | ||
| Security Risk Analysis | Yes | N/A |
| Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process. | ||
| Use of decision support and standardized treatment protocols | Yes | N/A |
| Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs. | ||
Clinician Utilization
The following Healthcare Common Procedure Coding System (HCPCS) codes were publicly reported as the top services rendered by this provider under the Medicare program for the year 2017. The reported codes are based on the top 5 codes for each available Medicare specialty, excluding evaluation and management codes.
- 150Injection, triamcinolone acetonide, not otherwise specified, 10 mg (HCPCS:J3301)
- 22Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)
- 19Repair of knee joint (HCPCS:27447)
Hospital Affiliations
Medicare hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the Medicare claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Benjamin Durham is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | CMS Certification Number (CCN) | Overall Rating |
|---|---|---|---|---|---|
| JACK HUGHSTON MEMORIAL HOSPITAL | 4401 RIVER CHASE DRIVE PHENIX CITY, AL 36867 | (334) 732-3000 | Acute Care Hospitals | 10168 | |
| UPSON REGIONAL MEDICAL CENTER | 801 W GORDON STREET THOMASTON, GA 30286 | (706) 647-8111 | Acute Care Hospitals | 110002 |
NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 0 | 0 | 3 | 0 | 0 | 6 | 1 | 1 | 5 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 0 | 0 | 3 | 0 | 0 | 12 | 1 | 2 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 0 + 0 + 3 + 0 + 0 + 1 + 2 + 1 + 2 + 24 = 35 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 40 - 35 = 5 | 5 | ||||||||
The NPI number 1003006115 is valid because the calculated check digit 5 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 3 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1902374226 | MORGAN MARIE DACOSTA PT, DPT Individual | Physical Therapist | 522 N CENTER ST THOMASTON, GA 30286 (706) 646-4371 |
| 1093237323 | KATHRYN GIBBS DPT Individual | Physical Therapist | 522 N CENTER ST THOMASTON, GA 30286 (706) 646-4371 |
| 1962763441 | DR. EDGAR JOSEPH DOLLAR II D.O. Individual | Family Medicine (Sports Medicine) | 522 N CENTER ST THOMASTON, GA 30286 (706) 646-4371 |
Frequently Asked Questions
What is Mr. Benjamin Durham PA-C NPI number?
The NPI number assigned to this healthcare provider is 1003006115, registered as an "individual" on July 26, 2007
Where is Mr. Benjamin Durham PA-C located?
The provider is located at 522 N Center St Thomaston, Ga 30286 and the phone number is (706) 646-4371
Which is Mr. Benjamin Durham PA-C specialty?
The provider's speciality is Physician Assistant
How many years of experience does Mr. Benjamin Durham PA-C have?
The provider has more than 16 years of experience. He graduated from Medical College Of Georgia School Of Medicine in 2007.
Is Mr. Benjamin Durham PA-C registered in PECOS?
Yes, as of May 11, 2023 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a Medicare beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
How much is a visit to Mr. Benjamin Durham PA-C?
Medicare beneficiaries should expect a typical cost of $85.45 with an average copayment of $21.36 for new patient appointments. Established patients should expect a typical charge of $69.44 and an average copayment of 17.36. Please review your insurance plan or contact the provider directly to determine your specific costs.
What are some of the services provided by Mr. Benjamin Durham PA-C?
The most common procedures or services performed by this practitioner are: Injection, triamcinolone acetonide, not otherwise specified, 10 mg, Aspiration and/or injection of large joint or joint capsule and Repair of knee joint.
Is Mr. Benjamin Durham PA-C affiliated to any hospitals?
The practitioner is affiliated to the following hospitals: JACK HUGHSTON MEMORIAL HOSPITAL and UPSON REGIONAL MEDICAL CENTER. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
How do I update my NPI information?
The NPI record of Mr. Benjamin Durham PA-C was last updated on July 26, 2007. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected]
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