Individual provider Active NPI

Bryan Lavoie

  • Physician Assistant
  • Wilmington, NC
National Provider Identifier
1225468119
Registry record updated Apr 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2032 S 17TH St
Suite 101
Wilmington, NC 28401-6677
Phone
(910) 763-3738
Fax
(910) 763-0454
NPI assigned
Nov 14, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2017

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 0010-04512 NC
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

2032 S 17TH St
Suite 101
Wilmington, NC 28401-6677

Mailing address

2032 S 17TH St
Suite 101
Wilmington, NC 28401-6677
Phone (910) 763-3738

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
I20140124001789 NC Practitioner - Physician Assistant 3971731746 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coastal Internal Medicine, P.a.Group PAC ID 9133181886, 6 clinicians

Practice addresses (Care Compare)

2032 S 17TH St
Wilmington, NC 28401-6678
Phone (910) 763-3738

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0010-04512NCMDMedical Physician Assistant

Interoperability endpoints

  • Direct secure messaging: bryan.lavoie@coastalinternalmedicine.eclinicaldirectplus.com

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 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": "1384387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493251200000",
    "number": "1225468119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2032 S 17TH ST",
            "address_2": "SUITE 101",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016677",
            "telephone_number": "910-763-3738",
            "fax_number": "910-763-0454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2032 S 17TH ST",
            "address_2": "SUITE 101",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016677",
            "telephone_number": "910-763-3738",
            "fax_number": "910-763-0454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAVOIE",
        "first_name": "BRYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-14",
        "last_updated": "2017-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-04512",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.