MR. BENJAMIN DURHAM PA-C
NPI 1003006115
Physician Assistant in Thomaston, GA

NPI Status: Active since July 26, 2007

Contact Information

522 N CENTER ST
THOMASTON, GA
ZIP 30286
Phone: (706) 646-4371
Fax: (706) 646-4372

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  • Individual
  • Male
  • Years of Experience 17
  • Physician Assistant
  • PECOS Enrolled
  • Accepts Medicare Approved Payment
  • Medicare Quality Reporting

About BENJAMIN DURHAM

Benjamin Durham is a primary care provider established in Thomaston, Georgia and his medical specialization is Physician Assistant with more than 17 years of experience. He graduated from Medical College Of Georgia School Of Medicine in 2007. The healthcare provider is registered in the NPI registry with number 1003006115 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.

NPI1003006115
Provider NameMR. BENJAMIN DURHAM PA-C
Location Address522 N CENTER ST THOMASTON, GA 30286
Location Phone(706) 646-4371
Mailing AddressPO BOX 370 FORTSON, GA 31808
GenderMale
Entity TypeIndividual
Medical School NameMEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
Graduation Year2007
Is Sole Proprietor?No
Enumeration Date07-26-2007
Last Update Date11-20-2020
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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 registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

The provider participated in CMS 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.

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Physician Assistant

Taxonomy Code
363A00000X
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.

Location Map

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) 322-2462
  • 100 N Macon St
    Macon, GA 31210
    (478) 200-6970

PECOS Enrollment and Medicare Participation Status

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.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • PECOS PAC ID: 9335223908

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20080221000313, I20110427000583

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • 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 to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

Physician Visit Costs

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 30286 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

  • Average New Patient Price $85.45
  • Minimum New Patient Price $55.19
  • Maximum New Patient Price $169.73
  • Average New Patient Copayment $21.36
  • Minimum New Patient Copayment $13.79
  • Maximum New Patient Copayment $42.43

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

  • Average Established Patient Price $69.44
  • Minimum Established Patient Price $16.8
  • Maximum Established Patient Price $138.36
  • Average Established Patient Copayment $17.36
  • Minimum Established Patient Copayment $4.2
  • Maximum Established Patient Copayment $34.59

* The physician office visit costs information is generated by 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 PatientsYesN/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 improvementsYesN/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 LevelYesN/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 AnalysisYesN/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 protocolsYesN/A
Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs.

Clinician Services

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 2020. The reported codes are based on the top 5 codes for each available specialty, excluding evaluation and management codes.

  • 150

    Injection, triamcinolone acetonide, not otherwise specified, 10 mg (HCPCS:J3301)

  • 22

    Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)

  • 19

    Repair of knee joint (HCPCS:27447)

Hospital Affiliations

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical 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 Overall Rating
JACK HUGHSTON MEMORIAL HOSPITAL4401 RIVER CHASE DRIVE
PHENIX CITY, AL 36867
(334) 732-3000Acute Care Hospitals
UPSON REGIONAL MEDICAL CENTER801 W GORDON STREET
THOMASTON, GA 30286
(706) 647-8111Acute Care Hospitals

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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.
1003006115
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2003001212
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 = 55

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 Therapist522 N CENTER ST
THOMASTON, GA 30286
(706) 646-4371
1093237323 KATHRYN GIBBS DPT
Individual
Physical Therapist522 N CENTER ST
THOMASTON, GA 30286
(706) 646-4371
1962763441DR. EDGAR JOSEPH DOLLAR II D.O.
Individual
Family Medicine (Sports Medicine)522 N CENTER ST
THOMASTON, GA 30286
(706) 646-4371

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1003006115, enumerated in the NPI registry as an "individual" on July 26, 2007

The provider is located at 522 N Center St Thomaston, Ga 30286 and the phone number is (706) 646-4371

The provider's speciality is Physician Assistant with taxonomy code 363A00000X

The provider has more than 17 years of experience. He graduated from Medical College Of Georgia School Of Medicine in 2007.

Yes, as of April 12, 2024 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a 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.

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.

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.

The practitioner is affiliated to the following hospital(s): 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.

This NPI record 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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