Individual provider Active NPI

Bryan Brown

  • Physician Assistant
  • Moreno Valley, CA
National Provider Identifier
1043023807
Registry record updated Apr 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
65891 Issued in CA
Practice address
26520 Cactus Ave
Moreno Valley, CA 92555-3927
Phone
(951) 486-4000
NPI assigned
Jan 27, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 65891 CA Primary

Addresses

Primary practice location

26520 Cactus Ave
Moreno Valley, CA 92555-3927

Mailing address

226 S Waverly St
Orange, CA 92866-2127

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260611003313 CA Practitioner - Physician Assistant 2466924303 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America - CaliforniaGroup PAC ID 6103739131, shared by 2 NPIs, 1,278 clinicians

Practice addresses (Care Compare)

9920 Talbert Ave
Fountain Valley, CA 92708-5153
Phone (714) 378-7000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1737936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744588800000",
    "number": "1043023807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 S WAVERLY ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928662127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26520 CACTUS AVE",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925553927",
            "telephone_number": "951-486-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "BRYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-27",
        "last_updated": "2025-04-14",
        "certification_date": "2025-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "65891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

Verify at the official NPI Registry.