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

Benjamin Illich

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1508277609

Benjamin Illich is an Emergency Medicine in Jackson, Mississippi. Qualified in 2014, 12 years ago. Practices with The Southeast Permanente Medical Group, a 826-clinician group and accepts Medicare assignment. Licensed in Mississippi.

Years since qualifying
12
Licensed in
MS
In the registry since
2014
Specialties on file
2
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Practice location Address checks out

2500 N State St
Jackson, MS 39216-4500
Phone: (228) 984-5582
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence 24710 (MS)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X · Licence 390200000 (MS)

Record details

NPI number1508277609
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 12, 2014
Last updated in NPPESFebruary 4, 2022
Mailing address2500 N State St, Jackson, MS 39216-4500

Medicare enrollment

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

Medicare specialtyEMERGENCY MEDICINE
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice The Southeast Permanente Medical Group — 826 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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