Individual provider Active NPI

David S Brantley, MD

  • Pediatrics Physician
  • Rocky Mount, NC
National Provider Identifier
1053305052
Registry record updated Mar 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
32645 Issued in NC
Practice address
91 Enterprise Dr
Rocky Mount, NC 27804-9590
Phone
(252) 451-3100
Fax
(252) 937-3106
NPI assigned
Sep 6, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 32645 NC Primary

Addresses

Primary practice location

91 Enterprise Dr
Rocky Mount, NC 27804-9590

Mailing address

PO Box 7200
Rocky Mount, NC 27804-0200
Phone (252) 937-0200

Other practice location 1

100 Nash Medical Arts Mall
Rocky Mount, NC 27804-1400
Phone (252) 451-3100

Other practice location 2

921 N Winstead Ave
Rocky Mount, NC 27804-8749
Phone (252) 937-0300

Other identifiers 7

IdentifierTypeStateIssuer
6262907OtherNCAENTA
8462532OtherNCCIGNA HEALTHCARE
891068GMedicaidNC
73705OtherNCMEDCOST
370008638OtherNCRAILROAD MEDICARE
1068GOtherNCBCBSNC
1735023OtherNCUNITED HEALTH CARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080403000200 NC Practitioner - Pediatric Medicine 0648357442 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
32645NCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Boice-Willis Clinic, PA CurrentSince May 11, 2013 Accepting new patients
Boice-Willis Clinic PA Pediatrics CurrentSince May 11, 2013 Accepting new patients

Locations

921 N Winstead Ave
Rocky Mount, NC 27804
Phone (252) 937-0300

91 Enterprise Dr
Rocky Mount, NC 27804
Phone (252) 451-3100

901 N Winstead Ave
Rocky Mount, NC 27804
Phone (252) 937-0200

91 Enterprise Dr
Fl 1
Rocky Mount, NC 27804

91 Enterprise Dr
Fl 2
Rocky Mount, NC 27804

100 Nash Medical Arts Mall
Rocky Mount, NC 27804
Phone (252) 451-3100

Interoperability endpoints

  • Direct secure messaging: david.brantley@bwc.eclinicaldirectplus.com

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": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551830400000",
    "number": "1053305052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7200",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278040200",
            "telephone_number": "252-937-0200",
            "fax_number": "252-451-0056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 ENTERPRISE DR",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278049590",
            "telephone_number": "252-451-3100",
            "fax_number": "252-937-3106"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Nash Medical Arts Mall",
            "address_purpose": "LOCATION",
            "city": "Rocky Mount",
            "state": "NC",
            "postal_code": "278041400",
            "country_code": "US",
            "telephone_number": "252-451-3100",
            "fax_number": "252-937-3106",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "921 N Winstead Ave",
            "address_purpose": "LOCATION",
            "city": "Rocky Mount",
            "state": "NC",
            "postal_code": "278048749",
            "country_code": "US",
            "telephone_number": "252-937-0300",
            "fax_number": "252-937-3108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRANTLEY",
        "first_name": "DAVID",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-06",
        "last_updated": "2019-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "32645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AENTA",
            "identifier": "6262907",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTHCARE",
            "identifier": "8462532",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891068G",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "73705",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "370008638",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "1068G",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "1735023",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rocky Mount, NC

Sources for this page

Verify at the official NPI Registry.