Individual provider Active NPI

Brian Behrendt, P.A.

  • Physician Assistant
  • London, KY
National Provider Identifier
1174757900
Registry record updated Mar 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1195 Issued in KY
Practice address
160 London Mountain View Dr
London, KY 40741-6601
Phone
(606) 864-0770
Fax
(606) 864-1461
NPI assigned
May 7, 2009
Last updated
Mar 10, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2015

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 TC016 KY
Physician Assistant 363A00000X PA1195 KY Primary

Addresses

Primary practice location

160 London Mountain View Dr
London, KY 40741-6601

Mailing address

100 E Liberty St
Suite 800
Louisville, KY 40202-1434
Phone (502) 315-1459

Other identifiers 1

IdentifierTypeStateIssuer
7100093470MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20090707000303 KY Practitioner - Physician Assistant 1355492158 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
H2 Rehabilitation Services of Kentucky, LLCGroup PAC ID 5799682688, shared by 7 NPIs, 187 clinicians

Practice addresses (Care Compare)

150 N Eagle Creek Dr
Lexington, KY 40509-1805
Phone (859) 967-5000

193 Glades Rd
Berea, KY 40403-2261
Phone (859) 956-1055

305 Estill St
Berea, KY 40403-1742
Phone (859) 386-9151

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA1195KYMDPhysician Assistant
TC016KYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cogent Healthcare of Kentucky, PSC Physician Assistant CurrentSince May 27, 2017 Accepting new patients

Locations

305 Estill St
Berea, KY 40403
Phone (859) 986-1415

1 Saint Joseph Dr
Lexington, KY 40504
Phone (502) 350-5000

150 N Eagle Creek Dr
Lexington, KY 40509
Phone (859) 267-9773

740 E Laurel Rd
London, KY 40741
Phone (606) 877-3931

5410 Maryland Way
Ste 300
Brentwood, TN 37027
Phone (615) 377-1674

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1241654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425945600000",
    "number": "1174757900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LIBERTY ST",
            "address_2": "SUITE 800",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021434",
            "telephone_number": "502-315-1459",
            "fax_number": "502-479-1425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 LONDON MOUNTAIN VIEW DR",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407416601",
            "telephone_number": "606-864-0770",
            "fax_number": "606-864-1461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEHRENDT",
        "first_name": "BRIAN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-07",
        "last_updated": "2015-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "TC016",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA1195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100093470",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in London, KY

Sources for this page

Verify at the official NPI Registry.