Individual provider Active NPI

Brenna Kate Houlihan, M.D.

  • Surgery Physician
  • Raleigh, NC
National Provider Identifier
1053739870
Registry record updated Oct 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2021-02574 Issued in NC
Practice address
3024 New Bern Ave Ste 102
Raleigh, NC 27610-1247
Phone
(919) 350-7331
NPI assigned
Mar 29, 2014
Last updated
Oct 12, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 12, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Surgery Physician 208600000X 202102574 NC
Surgery Physician 208600000X 2021-02574 NC Primary

Addresses

Primary practice location

3024 New Bern Ave Ste 102
Raleigh, NC 27610-1247

Mailing address

PO Box 603949
Charlotte, NC 28260-3949
Phone (919) 350-0351

Other identifiers 1

IdentifierTypeStateIssuer
1053739870MedicaidNC

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
I20211019001956 NC Practitioner - General Surgery 9739577065 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
New York Medical College, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wakemed Specialists Group LLCGroup PAC ID 2466788377, 868 clinicians

Practice addresses (Care Compare)

3024 New Bern Ave
Raleigh, NC 27610-1247
Phone (919) 350-7856

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy14
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
202102574NCMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wakemed Specialists Group LLC Multi-Specialty CurrentSince Oct 11, 2021 Accepting new patients
Wakemed Specialists Group, LLC Multi-Specialty CurrentSince Oct 11, 2021 Accepting new patients
Wakemed Specialists Group, LLC Multi-Specialty Current Accepting new patients

Locations

210 Ashville Ave
Cary, NC 27518
Phone (919) 235-6460

900 S Lombard St
Clayton, NC 27520
Phone (919) 350-7331

601 Attain St
Fuquay Varina, NC 27526
Phone (919) 235-6571

10010 Falls of Neuse Rd
Raleigh, NC 27614
Phone (919) 350-1380

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

3024 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-5318

3024 New Bern Ave
Ste 102
Raleigh, NC 27610
Phone (919) 350-7331

3024 New Bern Ave
Ste 307
Raleigh, NC 27610
Phone (919) 350-7231

1030 Siena Dr
Wake Forest, NC 27587
Phone (919) 235-6511

Interoperability endpoints

  • Direct secure messaging: bhoulihan373686@directhisp.wakemed.org

Organizations & group practices 3

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 3

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": "1396051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1053739870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603949",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603949",
            "telephone_number": "919-350-0351",
            "fax_number": "919-350-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3024 NEW BERN AVE STE 102",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101247",
            "telephone_number": "919-350-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOULIHAN",
        "first_name": "BRENNA",
        "middle_name": "KATE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-29",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "202102574",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "2021-02574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053739870",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.