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

Benjamin Randerson

Individual provider Physician Assistant · NPI 1285332072

Benjamin Randerson is a Physician Assistant in Kenosha, Wisconsin. Qualified in 2023, 3 years ago. Practices with Aurora Medical Group, Inc, a 3,741-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
3
Licensed in
WI
In the registry since
2023
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Practice location Address checks out

10400 75th St
Kenosha, WI 53142-7884
Phone: (262) 948-5600
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 507 North 17th Street, Milwaukee, WI 53233 — (414) 288-5688

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 7503 (WI)

Record details

NPI number1285332072
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedFebruary 21, 2023
Last updated in NPPESOctober 26, 2023
Certification dateOctober 26, 2023
Mailing addressPo Box 735044, Chicago, IL 60673-5044

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Aurora Medical Group, Inc. — 3741 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Kenosha