Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ben Prom

Individual provider Physician Assistant · NPI 1629733415

Ben Prom is a Physician Assistant in Juneau, Alaska. Qualified in 2021, 5 years ago. Practices with Divine Savior Healthcare Inc, a 132-clinician group and accepts Medicare assignment.

Years since qualifying
5
In the registry since
2021
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Practice location Address checks out

8505 Old Dairy Rd
Juneau, AK 99801-6921
Phone: (907) 790-4111
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1629733415
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedNovember 5, 2021
Last updated in NPPESNovember 5, 2021
Certification dateNovember 5, 2021
Mailing address8505 Old Dairy Rd, Juneau, AK 99801-6921

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Divine Savior Healthcare Inc — 132 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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