Brandon Micah Brevig, D.O.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

11-6037195 Issued in NY

Practice address

302 W Idaho St
Boise, ID 83702-6039

Phone

(208) 994-4962

Fax

(888) 913-3862

NPI assigned

May 25, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 30, 2015 through Nov 30, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Healing Touch Osteopathic PC

  • General Practice Physician
  • Garden City, ID
  • NPI 1306435490
  NPD Authorized official
• Ronald S Higginbotham, DO PA

  • Family Medicine Physician
  • Boise, ID
  • NPI 1306984943
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452038400000",
    "number": "1306057641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2032 E SIDEWINDER DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836465867",
            "telephone_number": "208-488-8408",
            "fax_number": "888-913-3862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W IDAHO ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026039",
            "telephone_number": "208-994-4962",
            "fax_number": "888-913-3862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREVIG",
        "first_name": "BRANDON",
        "middle_name": "MICAH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2016-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "11-6037195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GERALD TEPLITZ, DO",
            "identifier": "11-6037195",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracey Carol Breski, LPC-6531
• Katie Linnae Bressler, MD
• Macy Alexandra Bressner
• Bradley P Bretz, MD
• Darold Breuer, CADC
• Emily Brewer
• Paul M Brewer, O.D.
• Carrick Coleman Brewster, DDS
• Brian Bird DMD, PLLC
• Brianna Dawkins Counseling LLC

• All providers in Boise, ID
• Physical Medicine & Rehabilitation Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.