Active NPI
Brandon Emry
- Nurse Practitioner
- Fort Wayne, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 71007787A
- Practice address
- 11104 Parkview Circle Dr Ste 110
Fort Wayne, IN 46845-1673 - Phone
- (260) 425-6780
- NPI assigned
- Dec 14, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 28217961A | IN | |
| Nurse Practitioner | 363L00000X | 71007787A | IN | Primary |
Addresses
Primary practice location
11104 Parkview Circle Dr Ste 110
Fort Wayne, IN 46845-1673
Mailing address
3702 New Vision Dr BLDG B
Fort Wayne, IN 46845-1703
Phone (260) 266-6013
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
10021 Dupont Circle CT
Fort Wayne, IN 46825-1604
Phone (260) 426-8117
150 W Market St
Suite 400
Indianapolis, IN 46204-2810
Phone (855) 743-2247
8398 Mississippi St
FL 2
Merrillville, IN 46410-6316
Phone (855) 743-2247
Hospital & facility affiliations
- Parkview Regional Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28217961A | IN | MD | Registered Nurse |
| 71007787A | IN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cleanslate Medical Group of Indiana LLC | Current | Accepting new patients | |
| Ear, Nose & Throat Associates, PC | Current | Accepting new patients | |
| Extended Care Specialists, Inc | Nurse Practitioner | Current | Accepting new patients |
| Eventus Ecs, Inc | Nurse Practitioner | Current | Accepting new patients |
| The Hearing Center LLC | Past | Accepting new patients |
Locations
4925 S Scatterfield Rd
Anderson, IN 46013
Phone (765) 442-0402
4925 S Scatterfield Rd
#G
Anderson, IN 46013
Phone (765) 442-0402
424 Williams St
Angola, IN 46703
Phone (260) 665-2926
1169 N Main St
Ste 5
Bluffton, IN 46714
Phone (260) 827-4368
7926 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 459-6924
5411 Meijer Dr
Fort Wayne, IN 46835
Phone (260) 469-6919
3005 E State Blvd
Fort Wayne, IN 46805
Phone (260) 267-9498
10021 DuPont Circle Ct
Fort Wayne, IN 46825
Phone (219) 426-8117
2814 Theater Ave
Huntington, IN 46750
Phone (260) 356-3611
2003 Stults Rd
Ste 220
Huntington, IN 46750
Phone (260) 463-2133
150 W Market St
Ste 400
Indianapolis, IN 46204
8398 Mississippi St
Fl 2
Merrillville, IN 46410
1655 N Cass St
Wabash, IN 46992
Phone (260) 463-2133
737 N Detroit St
Ste 108
Warsaw, IN 46580
Phone (888) 881-4368
442 W High St
Bryan, OH 43506
Phone (260) 266-8210
140 Fox Rd
Van Wert, OH 45891
Phone (419) 238-7700
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 and National Provider Directory roles.
-
- Otolaryngology Physician
- Fort Wayne, IN
- NPI 1851377691
-
- Nurse Practitioner
- Indianapolis, IN
- NPI 1073353496
-
- Adult Medicine Physician
- Merrillville, IN
- NPI 1134146079
Nurse Practitioner
-
- Addiction Medicine (Internal Medicine) Physician
- Alexandria, IN
- NPI 1023464294
-
- Audiologist
- Fort Wayne, IN
- NPI 1891771655
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Fort Wayne, IN
- NPI 1366407603
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518566400000",
"number": "1164938007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3702 NEW VISION DR BLDG B",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468451703",
"telephone_number": "260-266-6013",
"fax_number": "260-458-5831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11104 PARKVIEW CIRCLE DR STE 110",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468451673",
"telephone_number": "260-425-6780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EMRY",
"first_name": "BRANDON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-14",
"last_updated": "2018-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IN",
"license": "28217961A",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "71007787A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2018; 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.