Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 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

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

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician.

  • Aspirus Divine Savior Hospital Hospital · Portage, WI

Colleagues at Divine Savior Healthcare Inc

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 132 clinicians in the practice; 12 are shown here.

Other providers in Juneau