Individual provider Active NPI

Wrenn Brotzman, PA-C

  • Physician Assistant
  • Goldsboro, NC
National Provider Identifier
1114555257
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2700 Wayne Memorial Dr
Goldsboro, NC 27534-9494
Phone
(919) 771-5585
NPI assigned
Apr 1, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary
Physician Assistant 363A00000X 0010-10553 NC

Addresses

Primary practice location

2700 Wayne Memorial Dr
Goldsboro, NC 27534-9494

Mailing address

809 Amber Forest Dr
Fuquay Varina, NC 27526-5781
Phone (919) 771-5585

Other identifiers 1

IdentifierTypeStateIssuer
0010-10553OtherNCNC MEDICAL LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address wbrotzman598097@direct.UNC.nchie.net Direct

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200923002112 NC Practitioner - Physician Assistant 0749609899 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Campbell Univ School of Osteopathic Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Emergency Physicians PAGroup PAC ID 9931002078, 269 clinicians

Practice addresses (Care Compare)

2700 Wayne Memorial Dr
Goldsboro, NC 27534-9494
Phone (919) 736-1110

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.58 of 100Reported as group
Quality
75.66
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Emergency Physicians PA CurrentSince Dec 1, 2023 Accepting new patients
Wake Emergency Physicians PA CurrentSince Dec 1, 2023 Accepting new patients

Locations

2700 Wayne Memorial Dr
Goldsboro, NC 27534
Phone (919) 731-6060

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

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1585699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1114555257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 AMBER FOREST DR",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275265781",
            "telephone_number": "919-771-5585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 WAYNE MEMORIAL DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275349494",
            "telephone_number": "919-771-5585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROTZMAN",
        "first_name": "WRENN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-01",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-10553",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC MEDICAL LICENSE",
            "identifier": "0010-10553",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wbrotzman598097@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "2700 Wayne Memorial Dr",
            "city": "Goldsboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275349494",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Goldsboro, NC

Sources for this page

Verify at the official NPI Registry.