Individual provider Active NPI

Brandy Rudin, NP-C

  • Gerontology Nurse Practitioner
  • Charlotte, NC
National Provider Identifier
1154717098
Registry record updated Jun 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
5007568 Issued in NC
Practice address
6047 Tyvola Glen Cir Ste 100
Charlotte, NC 28217-6431
Phone
(443) 383-9300
Fax
(855) 866-8710
NPI assigned
Apr 7, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 5007568 NC
Gerontology Nurse Practitioner 363LG0600X 5007568 NC Primary

Addresses

Primary practice location

6047 Tyvola Glen Cir Ste 100
Charlotte, NC 28217-6431

Mailing address

909 Ridgebrook Rd Ste 300
Sparks, MD 21152-9477
Phone (443) 383-9300

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
I20190416000600 NC Practitioner - Nurse Practitioner 4284947425 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chma of NCGroup PAC ID 5092108605, 21 clinicians

Practice addresses (Care Compare)

6047 Tyvola Glen Cir
Suite 100
Charlotte, NC 28217-6431
Phone (443) 383-9300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5007568NCMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Chma of NC CurrentSince Apr 25, 2022 Accepting new patients
Healing Partners Plus PLLC CurrentSince Sep 1, 2025 Accepting new patients

Locations

909 Ridgebrook Rd
Ste 300
Sparks Glencoe, MD 21152
Phone (443) 483-9300

4037 E Independence Blvd
Ste 100
Charlotte, NC 28205
Phone (267) 239-6447

6047 Tyvola Glen Cir
Charlotte, NC 28217
Phone (203) 238-7754

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686096000000",
    "number": "1154717098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 RIDGEBROOK RD STE 300",
            "city": "SPARKS",
            "state": "MD",
            "postal_code": "211529477",
            "telephone_number": "443-383-9300",
            "fax_number": "855-866-8710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6047 TYVOLA GLEN CIR STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282176431",
            "telephone_number": "443-383-9300",
            "fax_number": "855-866-8710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDIN",
        "first_name": "BRANDY",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-07",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NC",
            "license": "5007568",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NC",
            "license": "5007568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.