Bryan J Ebeling

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

239674 Issued in AZ

Practice address

1298 W Finnie Flat Rd
Camp Verde, AZ 86322-5958

Phone

(928) 639-5555

NPI assigned

Mar 23, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Urgent Care Northern Arizona Healthcare LLCGroup PAC ID 1557875481, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Flagstaff Medical Center Hospital, Flagstaff, AZ, CCN 030023

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Urgent Care Northern Arizona Healthcare LLC

  • Urgent Care Clinic/Center
  • Flagstaff, AZ
  • NPI 1730979634

  AZ

  Medicare reassignment Care Compare group NPD
• Innovative Wound Solutions, LLC

  • Multi-Specialty Clinic/Center
  • Scottsdale, AZ
  • NPI 1649038910

  AZ

  Medicare reassignment NPD
• Northern Arizona Healthcare Corporation

  • Family Medicine Physician
  • Flagstaff, AZ
  • NPI 1669914552

  AZ

  Medicare reassignment NPD
• Northern Arizona Healthcare Corporation

  • Multi-Specialty Clinic/Center
  • Flagstaff, AZ
  • NPI 1235732702
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Flagstaff Medical Center

  • Air Ambulance
  • Flagstaff, AZ
  • NPI 1427234111

  Hospital

  Care Compare affiliation
• Flagstaff Medical Center

  • Land Ambulance
  • Flagstaff, AZ
  • NPI 1518143205

  Hospital

  Care Compare affiliation
• Flagstaff Medical Center

  • Psychiatric Hospital Unit
  • Flagstaff, AZ
  • NPI 1649370875

  Hospital

  Care Compare affiliation
• Flagstaff Medical Center

  • General Acute Care Hospital
  • Flagstaff, AZ
  • NPI 1780635078

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1164058087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7805 W SWEETWATER TRL",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860018191",
            "telephone_number": "435-749-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1298 W FINNIE FLAT RD",
            "city": "CAMP VERDE",
            "state": "AZ",
            "postal_code": "863225958",
            "telephone_number": "928-639-5555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1298 W Finnie Flat Rd",
            "address_purpose": "LOCATION",
            "city": "Camp Verde",
            "state": "AZ",
            "postal_code": "863225958",
            "country_code": "US",
            "telephone_number": "928-639-5555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EBELING",
        "first_name": "BRYAN",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-23",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "239674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AANP",
            "identifier": "F03200300",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bryan.ebeling@nahealth.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1200 N Beaver St",
            "city": "Flagstaff",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "860013118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm
• Diamond D Rehab Fitness & Wellness
• Jennifer Dorn, NURSE PRACTITIONER
• Dr. Thomas C Scherich
• Leanna Drake, FNP-C
• Joseph Wayne Elio, PA
• Norma Irene Erivez, FNP
• Jared Matthew Evans, PHARM.D
• Karen Rae Fierro, RN
• Charlotte Floyd

• All providers in Camp Verde, AZ
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.