Individual provider Active NPI

Kent Philip Brantly, M.D.

  • Family Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1063745768
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01096271A Issued in IN
Practice address
10122 E 10TH St Ste 100
Indianapolis, IN 46229-2697
Phone
(317) 355-5717
NPI assigned
Sep 12, 2009
Last updated
Aug 5, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X P0816 TX
Family Medicine Physician 207Q00000X 01096271A IN Primary

Addresses

Primary practice location

10122 E 10TH St Ste 100
Indianapolis, IN 46229-2697

Mailing address

1617 Hemphill St
Fort Worth, TX 76104-4709
Phone (817) 702-2396

Other practice location 1

1500 S Main St
Fort Worth, TX 76104-4917
Phone (817) 702-2396

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150619000083 TX Practitioner - Family Practice 1456662386 Reassigns benefits to 1 organization
I20250813003773 IN Practitioner - Family Practice 1456662386 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 2009
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1503 N Mitthoefer Rd
Suite 150
Indianapolis, IN 46229-2425

6626 E 75TH St
Indianapolis, IN 46250-2890

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physicians of Indiana Inc Family Medicine CurrentSince Sep 1, 2025 Accepting new patients
Jane Pauley Community Health Center Inc CurrentSince Oct 24, 2025 Accepting new patients
Acclaim Physician Group, Inc CurrentSince May 1, 2016 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Sep 1, 2025 Accepting new patients

Locations

5819 Reliable Pkwy
Chicago, IL 60686

10122 E 10th St
Ste 100
Indianapolis, IN 46229
Phone (317) 355-5717

1503 N Mitthoefer Rd
Indianapolis, IN 46229

2040 N Shadeland Ave
Ste 300
Indianapolis, IN 46219
Phone (317) 355-3232

6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

8931 E 30th St
Indianapolis, IN 46219
Phone (317) 355-9320

1350 S Main St
Fl 1
Fort Worth, TX 76104
Phone (817) 702-3701

1500 S Main St
Ft Worth, TX 76104
Phone (817) 921-3431

1617 Hemphill St
Ft Worth, TX 76104
Phone (817) 702-3381

Interoperability endpoints

  • Direct secure messaging: kbrantly655509@ecommunitydirect.com
  • Direct secure messaging: kbrantly7023@direct.jpshealth.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1252713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1063745768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1617 HEMPHILL ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044709",
            "telephone_number": "817-702-2396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10122 E 10TH ST STE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462292697",
            "telephone_number": "317-355-5717"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 S Main St",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761044917",
            "country_code": "US",
            "telephone_number": "817-702-2396",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRANTLY",
        "first_name": "KENT",
        "middle_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-12",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "P0816",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01096271A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.