Individual provider Active NPI

Brandon Vorkink, PA-C

  • Physician Assistant
  • Manchester, MO
National Provider Identifier
1215642780
Registry record updated Jan 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2023001096 Issued in MO
Practice address
1044 La Bonne Pkwy Apt B
Manchester, MO 63088-1243
Phone
(660) 956-2238
NPI assigned
Jan 19, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2023

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 13174946-1206 UT
Physician Assistant 363A00000X 2023001096 MO Primary

Addresses

Primary practice location

1044 La Bonne Pkwy Apt B
Manchester, MO 63088-1243

Mailing address

1044 La Bonne Pkwy Apt B
Manchester, MO 63088-1243
Phone (660) 956-2238

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20230411000508 MO Practitioner - Physician Assistant 0648645382 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Signature Medical Group IncGroup PAC ID 4880598291, 40 clinicians

Practice addresses (Care Compare)

1011 Bowles Ave
Suite 100
Fenton, MO 63026-2387
Phone (314) 849-0311

12639 Old Tesson Rd
Saint Louis, MO 63128-2786
Phone 31484903112384

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13174946-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Signature Medical Group, Inc CurrentSince Apr 10, 2023 Accepting new patients
Signature Medical Group, Inc CurrentSince Apr 10, 2023 Accepting new patients

Locations

1011 Bowles Ave
Ste 100
Fenton, MO 63026

12639 Old Tesson Rd
Ste 115
Saint Louis, MO 63128
Phone (314) 842-8655

Interoperability endpoints

  • Direct secure messaging: brandon.vorkink@direct.signature.nextgenshare.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 2

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": "1674086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674086400000",
    "number": "1215642780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 LA BONNE PKWY APT B",
            "city": "MANCHESTER",
            "state": "MO",
            "postal_code": "630881243",
            "telephone_number": "660-956-2238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 LA BONNE PKWY APT B",
            "city": "MANCHESTER",
            "state": "MO",
            "postal_code": "630881243",
            "telephone_number": "660-956-2238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VORKINK",
        "first_name": "BRANDON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-19",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "13174946-1206",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2023001096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, MO

Sources for this page

Verify at the official NPI Registry.