NPIMap

Individual provider Active NPI

Tanner Paul Brondhaver, DO

  • Family Medicine Physician
  • Morehead, KY
National Provider Identifier
1013597608
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R5677 Issued in KY
Practice address
222 Medical Cir
Morehead, KY 40351-1179
Phone
(606) 783-6455
Fax
(606) 784-2767
NPI assigned
Apr 9, 2021
Last updated
Jun 14, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R5677 KY Primary

Addresses

Primary practice location

222 Medical Cir
Morehead, KY 40351-1179

Mailing address

222 Medical Cir
Morehead, KY 40351-1179
Phone (606) 783-6455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240815003320 KY Practitioner - Family Practice 0345623880 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lincoln Mem Univ, Debusk Col of Osteopathic Med, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St. Claire Medical Center IncGroup PAC ID 4486559085, 181 clinicians

Practice addresses (Care Compare)

316 W 2ND St
Morehead, KY 40351-1550
Phone (606) 784-3771

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
73.64 of 100Reported as group
Quality
56.63
Improvement activities
40
Cost
74.98

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
St. Claire Medical Center, Inc Current Accepting new patients
St. Claire Medical Center, Inc CurrentSince Aug 1, 2024 Accepting new patients
St. Claire Medical Center, Inc Family Medicine Current Accepting new patients
St. Claire Medical Center,Inc Current Accepting new patients
St Claire Medical Center, Inc CurrentSince Aug 1, 2024 Accepting new patients
St. Claire Medical Center,Inc Current Accepting new patients
St Claire Medical Center, Inc., Family Medicine Current Accepting new patients
West Liberty Nursing and Rehabilitation LLC Past Accepting new patients
Sprocket Medical Management LLC Past Accepting new patients

Locations

732 Highway 36
Frenchburg, KY 40322
Phone (606) 768-2191

222 Medical Cir
Morehead, KY 40351
Phone (606) 783-6500

245 Flemingsburg Rd
Morehead, KY 40351
Phone (606) 780-5500

316 W 2nd St
Morehead, KY 40351
Phone (606) 783-6400

632 Slate Ave
Owingsville, KY 40360
Phone (606) 674-6386

390 S Ky 7
Sandy Hook, KY 41171
Phone (606) 738-5155

Networks

  • KY PPO

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
West Liberty Nursing and Rehabilitation LLCWest Liberty, KY, CCN 185274 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2025
Jan 1, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1013597608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 MEDICAL CIR",
            "city": "MOREHEAD",
            "state": "KY",
            "postal_code": "403511179",
            "telephone_number": "606-783-6455",
            "fax_number": "606-784-2767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 MEDICAL CIR",
            "city": "MOREHEAD",
            "state": "KY",
            "postal_code": "403511179",
            "telephone_number": "606-783-6455",
            "fax_number": "606-784-2767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONDHAVER",
        "first_name": "TANNER",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-09",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "R5677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morehead, KY

Sources for this page

Verify at the official NPI Registry.