Alan Steven Brenner, M.D.

Primary specialty

Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X

License

MD2012-0882 Issued in NM

Practice address

201 Cedar St SE
Suite 4600
Albuquerque, NM 87106-4917

Phone

(505) 563-6450

Fax

(505) 563-6484

NPI assigned

Jan 21, 2007

Last updated

May 13, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Tuba City Regional Health Care Corporation

  dba Tuba City Indian Medical Center

  • General Acute Care Hospital
  • Tuba City, AZ
  • NPI 1548294424

  Otolaryngology, TX

  Medicare reassignment NPD
• Lechee Health Facility

  • Clinic/Center
  • Lechee, AZ
  • NPI 1831448398
  NPD
• Tuba City Regional Health Care Corporation

  dba Bodaway Gap Clinic

  • Family Medicine Physician
  • Bodaway Gap, AZ
  • NPI 1710519913
  NPD
• Proliance Surgeons Inc P S

  dba Proliance Orthopedic Associates

  • Orthopaedic Surgery Physician
  • Renton, WA
  • NPI 1235091463
  NPD (past)
• Proliance Surgeons, Inc., P.S.

  dba Proliance Eastside ENT

  • Otolaryngology Physician
  • Kirkland, WA
  • NPI 1528304292
  NPD (past)

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

{
    "created_epoch": "1169337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368403200000",
    "number": "1063565075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 CEDAR ST SE",
            "address_2": "SUITE 4600",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064917",
            "telephone_number": "505-563-6450",
            "fax_number": "505-563-6484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 CEDAR ST SE",
            "address_2": "SUITE 4600",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064917",
            "telephone_number": "505-563-6450",
            "fax_number": "505-563-6484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNER",
        "first_name": "ALAN",
        "middle_name": "STEVEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-21",
        "last_updated": "2013-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "NM",
            "license": "MD2012-0882",
            "primary": true
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "WA",
            "license": "MD00016472",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "SD",
            "license": "8123",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "NM",
            "license": "MD2012-0882",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6301580",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1158609",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "G000100601",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paula J Brennan, RNFA
• Sarah Kathleen Brennan, PH.D.
• Tara Eileen Brennan, M.D.
• Whitney Leigh Brennan, CNP
• Michael D Brennand, PA-C
• Cynthia L Brenner, MD
• Joanna Marie Brenner, LMT
• Lindsay Brenner
• Mara Brenner, LPCC
• Tamara Brenno-Uribarri, COTA/L

• Facial Plastic Surgery Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Facial Plastic Surgery Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.