Individual provider Active NPI

Brandon Neidert, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Canton, OH
National Provider Identifier
1255855292
Registry record updated Jun 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
021415 Issued in OH
Practice address
1320 Mercy Dr NW
Canton, OH 44708-2614
Phone
(330) 489-1000
NPI assigned
Aug 1, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 021415 OH Primary
Registered Nurse 163W00000X 362722 OH

Addresses

Primary practice location

1320 Mercy Dr NW
Canton, OH 44708-2614

Mailing address

1320 Mercy Dr NW
Canton, OH 44708-2614
Phone (330) 489-1000

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
I20230303000741 OH Practitioner - Nurse Practitioner 2860865359 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

9500 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-5433

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
362722OHMDRegistered Nurse
021415OHMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cleveland Clinic Mercy Hospital CurrentSince Jan 1, 2023 Accepting new patients
The Cleveland Clinic Foundation CurrentSince Mar 8, 2023 Accepting new patients
Cleveland Clinic Mercy Hospital PastSince Jan 1, 2023 Accepting new patients

Locations

1 Akron General Ave
Akron, OH 44307
Phone (330) 344-5760

1320 Timken Mercy Dr NW
Canton, OH 44708
Phone (330) 489-1000

1330 Mercy Dr NW
Ste 200
Canton, OH 44708
Phone (330) 489-1000

1320 Mercy Dr NW
Spc Ser
Canton, OH 44708
Phone (330) 492-8720

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

Organizations & group practices 3

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 1

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": "1501545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561507200000",
    "number": "1255855292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 MERCY DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447082614",
            "telephone_number": "330-489-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 MERCY DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447082614",
            "telephone_number": "330-489-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEIDERT",
        "first_name": "BRANDON",
        "name_prefix": "Mr.",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-01",
        "last_updated": "2019-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OH",
            "license": "021415",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "362722",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.