Individual provider Active NPI

Brandon Emry

  • Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1164938007
Registry record updated Feb 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71007787A Issued in IN
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

Updated by the provider on Feb 14, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180314001055 IN Practitioner - Nurse Practitioner 9032471826 Reassigns benefits to 4 organizations

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
Ear Nose and Throat Associates PCGroup PAC ID 3375504301, 36 clinicians
Eventus Ecs, IncGroup PAC ID 2163969650, 243 clinicians
Extended Care Specialists, IncGroup PAC ID 2466407713, 295 clinicians

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 Hospital, Fort Wayne, IN, CCN 150021

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28217961AINMDRegistered Nurse
71007787AINMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cleanslate Medical Group of Indiana LLC CurrentSince Nov 1, 2020 Accepting new patients
Ear, Nose & Throat Associates, PC CurrentSince Jan 19, 2022 Accepting new patients
Extended Care Specialists, Inc Nurse Practitioner CurrentSince Feb 1, 2026 Accepting new patients
Eventus Ecs, Inc Nurse Practitioner CurrentSince Feb 1, 2026 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.

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": "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

Verify at the official NPI Registry.