Individual provider Active NPI

Christy Tucker Bracken, PA-C

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1194766477
Registry record updated Jul 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
104021 Issued in NC
Practice address
Medical Center Blvd
Emergency Department
Winston Salem, NC 27157-0001
Phone
(336) 716-8740
Fax
(336) 716-0345
NPI assigned
Jun 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 104021 NC
Physician Assistant 363A00000X 104021 NC Primary

Addresses

Primary practice location

Medical Center Blvd
Emergency Department
Winston Salem, NC 27157-0001

Mailing address

Department of Emergency Medicine
Medical Center Blvd
Winston Salem, NC 27157-1089
Phone (336) 716-8740

Other identifiers 1

IdentifierTypeStateIssuer
202781OtherMEDCOST

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20040830000892 NC Practitioner - Physician Assistant 3173598422 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1319 New Garden Rd
Greensboro, NC 27410-2722
Phone (336) 716-9622

3120 Northline Ave
Greensboro, NC 27408-7814

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
104021NCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Jan 29, 2007 Accepting new patients
Johnson Neurological Clinic, Inc. Past Accepting new patients

Locations

606 N Elm St
High Point, NC 27262
Phone (336) 884-0224

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

650 Highland Ave
Ste 120
Winston Salem, NC 27101
Phone (336) 713-6111

Interoperability endpoints

  • Direct secure messaging: cbracken4886@direct.novanthealth.org
  • Direct secure messaging: cbracken2755294@carolinashealthcaresystem.direct-ci.com

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.

Hospital & facility affiliations 5

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": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372723200000",
    "number": "1194766477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPARTMENT OF EMERGENCY MEDICINE",
            "address_2": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271571089",
            "telephone_number": "336-716-8740",
            "fax_number": "336-716-0345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-8740",
            "fax_number": "336-716-0345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACKEN",
        "first_name": "CHRISTY",
        "middle_name": "TUCKER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-09",
        "last_updated": "2013-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "104021",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "104021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "202781",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.