Individual provider Active NPI

Patricia J Brunett-Wolpert, ACNP

  • Acute Care Nurse Practitioner
  • Dayton, OH
National Provider Identifier
1184859126
Registry record updated Nov 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
10677-NP Issued in OH
Practice address
1222 S Patterson Blvd
Suite 120
Dayton, OH 45402-2684
Phone
(937) 208-8885
Fax
(937) 208-8895
NPI assigned
May 20, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 10677-NP OH Primary

Addresses

Primary practice location

1222 S Patterson Blvd
Suite 120
Dayton, OH 45402-2684

Mailing address

1222 S Patterson Blvd
Suite 120
Dayton, OH 45402-2684
Phone (937) 208-8885

Other identifiers 1

IdentifierTypeStateIssuer
2962012MedicaidOH

Other names 1

  • Patricia J Brunett Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20090729000034 OH Practitioner - Nurse Practitioner 4789737420 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Health Specialists IncGroup PAC ID 5597708594, 576 clinicians

Practice addresses (Care Compare)

9000 N Main St
Englewood, OH 45415-1180
Phone (937) 208-8394

Merit-based Incentive Payment System (MIPS)

Final score
84.17 of 100Reported as group
Quality
65.6
Promoting interoperability
100
Improvement activities
40
Cost
74.7

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
10677-NPOHMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Health Specialists Inc CurrentSince Mar 16, 2022 Accepting new patients
Premier Heart Associates, Inc Past Accepting new patients

Locations

1 Wyoming St
Dayton, OH 45409
Phone (937) 208-2636

9000 N Main St
Englewood, OH 45415
Phone (937) 208-8394

450 N Hyatt St
Ste 304
Tipp City, OH 45371
Phone (937) 832-4773

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": "1242777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384473600000",
    "number": "1184859126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1222 S PATTERSON BLVD",
            "address_2": "SUITE 120",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454022684",
            "telephone_number": "937-208-8885",
            "fax_number": "937-208-8895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 S PATTERSON BLVD",
            "address_2": "SUITE 120",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454022684",
            "telephone_number": "937-208-8885",
            "fax_number": "937-208-8895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNETT-WOLPERT",
        "first_name": "PATRICIA",
        "middle_name": "J",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-20",
        "last_updated": "2013-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OH",
            "license": "10677-NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2962012",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PATRICIA",
            "last_name": "BRUNETT",
            "middle_name": "J",
            "credential": "ACNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.