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DR. BENJAMIN HEATH DURHAM M.D.
NPI 1164690483
Pathology - Anatomic Pathology & Clinical Pathology in New Brunswick, NJ

Active since February 20, 2008PECOS EnrolledAccepts Medicare Assignment
76.15/100
CMS Quality Rating
195 LITTLE ALBANY ST RM 4557, NEW BRUNSWICK, NJ 08901(732) 235-9718 Get Directions Write a Review

NPPES record last updated: December 4, 2023. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Dr. Benjamin Heath Durham M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. BENJAMIN HEATH DURHAM M.D. (NPI 1164690483) is an individual anatomic pathology & clinical pathology provider in New Brunswick, New Jersey, licensed in New Jersey (25MA11324200) and active in the NPI registry since February 2008. He is enrolled in Medicare PECOS, is affiliated with Robert Wood Johnson University Hospital, and is a graduate of University Of Alabama School Of Medicine (2007).

NPPES Registry Identity

NPI1164690483
Entity TypeIndividualMale
Primary Taxonomy207ZP0102X
Provider Legal NameDR. BENJAMIN HEATH DURHAMCredential: M.D.
Location Address195 LITTLE ALBANY ST RM 4557New Brunswick, NJ 08901-1914
Mailing Address110 Somerset St Apt 2008New Brunswick, NJ 08901-4810 · (256) 574-9779
Phone(732) 235-9718
Sole ProprietorNo
Medical School CMSUniversity Of Alabama School Of MedicineGraduated 2007
Enumeration DateFebruary 20, 2008
Last NPPES UpdateDecember 4, 2023
NPPES CertifiedDecember 4, 2023
✔ NPI 1164690483 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPathology · Anatomic Pathology & Clinical PathologyAllopathic & Osteopathic Physicians
Taxonomy Code207ZP0102X
Licenses✔ Licensed in NJ · 25MA11324200✔ Licensed in NY · 270378✔ Licensed in CA · 120870
Definition
A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.
Also ListedPathology · HematologyTaxonomy 207ZH0000X · License 25MA11324200 (NJ), 270378 (NY), 120870 (CA)
Also ListedPathology · Molecular Genetic PathologyTaxonomy 207ZP0007X · License 25MA11324200 (NJ), 270378 (NY), 120870 (CA)
195 LITTLE ALBANY ST RM 4557, New Brunswick, NJ 08901
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Oscar Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Benjamin Heath Durham M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6305106485
PECOS Enrollment IDI20231103000656
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

3

Medicare enrollment records show Benjamin Durham reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Rutgers Health-Rwj Scleroderma Program
Same address
Pediatric Hematology-Oncology
195 LITTLE ALBANY ST
New Brunswick, NJ 08901
  • Reassigned Medicare billing, New Jersey enrollment
  • 641 clinicians in this Medicare group
NPI 1104842285 (732) 235-6455
Rutgers Health-Rwj Pediatric Critical Care
0.1 mi
Anesthesiology
125 PATERSON ST STE 5123
New Brunswick, NJ 08901
  • Reassigned Medicare billing, New Jersey enrollment
  • 492 clinicians in this Medicare group
NPI 1063420776 (732) 235-7246
Memorial Pathology Group
32 mi
Anatomic Pathology & Clinical Pathology
1275 YORK AVE
New York, NY 10065
  • Reassigned Medicare billing, New York enrollment
  • 116 clinicians in this Medicare group
NPI 1710967369 (646) 227-3813

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Molecular pathology procedure; physician interpretation and report G0452
A molecular pathology procedure involves analyzing your body's cells at a molecular level to identify any abnormalities. This can help detect diseases early. A physician will interpret the results and provide a detailed report, explaining the findings clearly.
52 services49 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Robert Wood Johnson University Hospital

Acute Care Hospitals · New Brunswick, NJ
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number310038
LocationOne Robert Wood Johnson PlaceNew Brunswick, NJ 08901 · Middlesex County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 08901 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$144.86 typical visit price
range $63.84 – $190.92
Typical copayment $36.21 (range $15.96 – $47.73)
Most-billed visit code 99204
Established Patient
$111.57 typical visit price
range $20.97 – $155.92
Typical copayment $27.89 (range $5.24 – $38.98)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

76.15/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality70
Improvement Activities40

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Benjamin Durham's NPI number?

The NPI number for Benjamin Durham is 1164690483. It was assigned to this individual provider in the NPPES registry on February 20, 2008.

Where is Benjamin Durham located?

Benjamin Durham practices at 195 Little Albany St Rm 4557, New Brunswick, NJ 08901. The listed phone number is (732) 235-9718.

What is Benjamin Durham's specialty?

The primary specialty registered for this NPI is Pathology, specializing in Anatomic Pathology & Clinical Pathology, with taxonomy code 207ZP0102X.

Is Benjamin Durham enrolled in Medicare?

Yes. Benjamin Durham is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Benjamin Durham's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Benjamin Durham reassigns Medicare benefits to 3 organizations: Rutgers Health-Rwj Scleroderma Program (New Brunswick, NJ), Rutgers Health-Rwj Pediatric Critical Care (New Brunswick, NJ) and Memorial Pathology Group (New York, NY). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Benjamin Durham's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Benjamin Durham accept?

Health plans from Oscar Health list Benjamin Durham as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Benjamin Durham affiliated with any hospitals?

According to CMS data, Benjamin Durham is affiliated with Robert Wood Johnson University Hospital.

When was this NPI record last updated?

The NPPES record for Benjamin Durham was last updated on December 4, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.