Basic Information
Provider Information | |||||||||
NPI: | 1982644886 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HILL | ||||||||
FirstName: | BENJAMIN | ||||||||
MiddleName: | H | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 104 WOODMONT BLVD | ||||||||
Address2: | SUITE LL50 | ||||||||
City: | NASHVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 372052245 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6153862300 | ||||||||
FaxNumber: | 6153862399 | ||||||||
Practice Location | |||||||||
Address1: | 4230 HARDING RD | ||||||||
Address2: | SUITE 400 | ||||||||
City: | NASHVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 372052013 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6152972700 | ||||||||
FaxNumber: | 6152694584 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/08/2006 | ||||||||
LastUpdateDate: | 06/22/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 30787 | TN | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 12540282 | 01 | TN | MULTIPLAN/PHCS | OTHER | 10078359 | 01 | TN | AMERIGROUP | OTHER | 1100373838 | 01 | TN | USA PPO/GEHA | OTHER | 1507914 | 05 | TN |   | MEDICAID | 4028013 | 01 | TN | BLUE CROSS OF TN | OTHER | 7021285 | 01 | TN | AETNA | OTHER | 2165496 | 01 | TN | UNITED HEALTH CARE | OTHER | 1074556 | 01 | TN | USA MANAGED CARE | OTHER | 4811562 | 01 | TN | CIGNA | OTHER | 64062029 | 05 | KY |   | MEDICAID | P00076595 | 01 | TN | MEDICARE RR | OTHER | 1023432 | 01 | TN | COVENTRY | OTHER |