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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

BENJAMIN JACOB SULLIVAN PA-C
NPI 1710684758
Physician Assistant - Medical in Greensboro, NC

Active since February 09, 2023PECOS Enrolled
2005 PISGAH CHURCH RD, GREENSBORO, NC 27455(336) 716-9150(336) 702-9166 Get Directions Write a Review

NPPES record last updated: September 15, 2026. Verified against the NPPES registry weekly; last sync: September 27, 2026.

Record update history: Sep 15, 2026, Mar 10, 2025, Feb 10, 2025 and 4 more (7 updates tracked since 2023).

About Benjamin Jacob Sullivan Pa-c NPPES

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

BENJAMIN JACOB SULLIVAN PA-C (NPI 1710684758) is an individual medical provider in Greensboro, North Carolina, licensed in Iowa (129254) and active in the NPI registry since February 2023. He is enrolled in Medicare PECOS and maintains a secondary practice location in Iowa City.

NPPES Registry Identity

NPI1710684758
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameBENJAMIN JACOB SULLIVANCredential: PA-C
Location Address2005 PISGAH CHURCH RDGreensboro, NC 27455-3309
Mailing Address2005 Pisgah Church RdGreensboro, NC 27455-3309 · (336) 716-9150 · Fax (336) 702-9166
Phone(336) 716-9150
Fax(336) 702-9166
Sole ProprietorNo
Enumeration DateFebruary 9, 2023
Last NPPES UpdateSeptember 15, 20267 updates tracked since enumeration
NPPES CertifiedSeptember 15, 2026
✔ NPI 1710684758 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in IA · 129254
Also ListedPhysician AssistantTaxonomy 363A00000X · License 0010-16580 (NC)
2005 PISGAH CHURCH RD, Greensboro, NC 27455
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Secondary Practice Location 1

Location 1200 Hawkins DrIowa City, IA 52242-1009 · Phone (319) 356-2233 · Fax (319) 356-0533

Other Identifiers 1

MedicaidQ081975TN

Accepted Insurance

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

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Benjamin Jacob Sullivan Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LINDSI AHEARN CPNP-AC
Nurse Practitioner (Pediatrics, Critical Care)
2005 PISGAH CHURCH RD
GREENSBORO, NC 27455
Guilford County (336) 716-9150
MICHAEL YOUNSHIK GHIM MD
Emergency Medicine
2005 PISGAH CHURCH RD, SUITE A
GREENSBORO, NC 27455
Guilford County (336) 701-2662
TRIAD URGENT CARE PLLC
Clinic/Center (Urgent Care)
2005 PISGAH CHURCH RD, SUITE A
GREENSBORO, NC 27455
Guilford County (336) 701-2662
KIARA WINSOR FNP-BC
Nurse Practitioner (Family)
2005 PISGAH CHURCH RD
GREENSBORO, NC 27455
Guilford County (336) 716-9150
MRS. DESIRAE JO VOIGT PNP-AC
Nurse Practitioner (Pediatrics)
2005 PISGAH CHURCH RD
GREENSBORO, NC 27455
Guilford County (336) 716-9150
MAGGIE WHITT MAZUREK FNP-C
Nurse Practitioner (Family)
2005 PISGAH CHURCH RD
GREENSBORO, NC 27455
Guilford County (336) 701-2662
LISA ANN GROSS PA-C
Physician Assistant
2005 PISGAH CHURCH RD
GREENSBORO, NC 27455
Guilford County (336) 716-9150
MORGAN ANN GARDNER MD
Pediatrics
2005 PISGAH CHURCH RD
GREENSBORO, NC 27455
Guilford County (336) 716-9150

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 Sullivan's NPI number?

The NPI number for Benjamin Sullivan is 1710684758. It was assigned to this individual provider in the NPPES registry on February 9, 2023.

Where is Benjamin Sullivan located?

Benjamin Sullivan practices at 2005 Pisgah Church Rd, Greensboro, NC 27455. The listed phone number is (336) 716-9150.

What is Benjamin Sullivan's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Benjamin Sullivan enrolled in Medicare?

Yes. Benjamin Sullivan is registered in the Medicare PECOS enrollment system.

What insurance does Benjamin Sullivan accept?

Health plans from Medica list Benjamin Sullivan 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.

When was this NPI record last updated?

The NPPES record for Benjamin Sullivan was last updated on September 15, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 days 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.