Brenda Faye Gavin, APRN FNP-C AG-ACNP-C

Key facts

NPI

1265812424

Entity type

Individual (NPI type 1)

Primary specialty

Gerontology Nurse Practitioner 363LG0600X

License

1-087281 (AL)

Practice address

100 Memorial Hospital Dr Ste 1a
Mobile, AL 36608-1128

Phone

(251) 343-6848

Fax

(251) 343-5708

NPI assigned

Jun 3, 2015

Sex

Female

Sole proprietor

Yes

Organizations & group practices 6

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.

• Paragon Emergency Services LLC Emergency Medicine Physician · Winter Haven, FL · NPI 1912101650
  Medicare reassignment Care Compare group NPD FL
• Baldwin Emergency Physicians, P.C.. Emergency Medicine Physician · Fairhope, AL · NPI 1154378271
  Medicare reassignment NPD AL
• Pulmonary Associates of Mobile PC Critical Care Medicine (Internal Medicine) Physician · Mobile, AL · NPI 1194776278
  Medicare reassignment NPD AL
• Hni Hospital Services of Florida, LLC Critical Care Medicine (Internal Medicine) Physician · Panama City, FL · NPI 1144851411
  Medicare reassignment NPD ACUTE CARE · FL
• Pulmonary Associates of Mobile PC Pulmonary Disease Physician · Mobile, AL · NPI 1750366118
  NPD
• Pulmonary Associates of Mobile PC Critical Care Medicine (Internal Medicine) Physician · Mobile, AL · NPI 1689624835
  NPD (past)

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• West Florida Regional Medical Center, Inc. General Acute Care Hospital · Pensacola, FL · NPI 1639116726
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Paragon Emergency Services LLC (401 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida West Hospital Hospital · Pensacola, FL · CCN 100231

Medicare participation

Medicare fee-for-service enrollment

Enrolled (2 enrollments) in AL, FL

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 2, 2020.

{
    "created_epoch": "1433289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1265812424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7987",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366700987",
            "telephone_number": "251-633-0573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEMORIAL HOSPITAL DR STE 1A",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366081128",
            "telephone_number": "251-343-6848",
            "fax_number": "251-343-5708"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8725 County Road 64",
            "address_purpose": "LOCATION",
            "city": "Daphne",
            "state": "AL",
            "postal_code": "365266061",
            "country_code": "US",
            "telephone_number": "251-625-1370",
            "fax_number": "251-625-1380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2001 Spring Hill Ave",
            "address_purpose": "LOCATION",
            "city": "Mobile",
            "state": "AL",
            "postal_code": "366073326",
            "country_code": "US",
            "telephone_number": "251-433-3344",
            "fax_number": "251-433-4052",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5955 Airport Blvd",
            "address_purpose": "LOCATION",
            "city": "Mobile",
            "state": "AL",
            "postal_code": "366083135",
            "country_code": "US",
            "telephone_number": "251-633-0573",
            "fax_number": "251-633-7367",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAVIN",
        "first_name": "BRENDA",
        "middle_name": "FAYE",
        "credential": "APRN FNP-C AG-ACNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-03",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-087281",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AL",
            "license": "1-087281",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "R900157",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "6858582",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08101023",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "512-42739",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250441",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "512-42738",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "512-42741",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA MILITARY",
            "identifier": "1265812424",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250364",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250414",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGNOLIA HEALTH",
            "identifier": "1265812424",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250605",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "512-42742",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "5896052",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "A03966A",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIVA HEALTH",
            "identifier": "Z27049",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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