Individual provider Active NPI

Brandon Howard Forester, P.A.

  • Surgical Physician Assistant
  • Phoenix, AZ
National Provider Identifier
1104124007
Registry record updated Oct 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
5079 Issued in AZ
Practice address
1111 E McDowell Rd
Phoenix, AZ 85006-2612
Phone
(602) 839-2000
NPI assigned
Mar 2, 2011
Last updated
Oct 16, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 56001005935 MI
Surgical Physician Assistant 363AS0400X 5079 AZ Primary

Addresses

Primary practice location

1111 E McDowell Rd
Phoenix, AZ 85006-2612

Mailing address

21531 N 61St St
Phoenix, AZ 85054-5813
Phone (480) 385-8583

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20120502000275 AZ Practitioner - Physician Assistant 3072775329 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1520 S Dobson Rd
Suite 210
Mesa, AZ 85202-4753
Phone (602) 258-4788

370 E Virginia Ave
Suite 100
Phoenix, AZ 85004-1254
Phone (602) 258-4788

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5079AZMDSurgical Physician Assistant
56001005935MIMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Arizona Center for Hand Surgery PC CurrentSince Mar 21, 2012 Accepting new patients
Honorhealth CurrentSince Oct 1, 2012 Accepting new patients

Locations

15830 N 35th Ave
Ste 1
Phoenix, AZ 85053
Phone (602) 298-1188

370 E Virginia Ave
Ste 100
Phoenix, AZ 85004
Phone (602) 200-8988

7400 E Osborn Rd
Scottsdale, AZ 85251
Phone (480) 481-4000

Organizations & group practices 5

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": "1299024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760572800000",
    "number": "1104124007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21531 N 61ST ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850545813",
            "telephone_number": "480-385-8583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 E MCDOWELL RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062612",
            "telephone_number": "602-839-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORESTER",
        "first_name": "BRANDON",
        "middle_name": "HOWARD",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-02",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "56001005935",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "5079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.