Brandon Blakely Bisso, NP
Individual provider Active NPI Nurse Practitioner · Lagrange, GA
NPI 1306401260 · NPPES record last updated May 7, 2019
Key facts
- NPI
- 1306401260
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- RN220792 (GA)
- Practice address
- 1514 Vernon Rd
Lagrange, GA 30240-4131 - Phone
- (706) 882-1411
- NPI assigned
- May 7, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- The Bortolazzo Group, LLC
Practice addresses (Care Compare)
3950 Austell Rd
Austell, GA 30106-1121
Phone (770) 732-4000
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.93 of 100
- Quality
- 82.14
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190824000578 | GA | Practitioner - Nurse Practitioner | 1658609961 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN220792 | GA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Bortolazzo Group, LLC | Current |
Accepting new patients | |
| Lagrange Emergency Physicians, LLC | Current |
Accepting new patients | |
| Gordon Emergency Physicians, LLC | Current |
Accepting new patients | |
| Gordon Emergency Physicians, LLC | Current |
Accepting new patients |
Locations
3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752
1035 Red Bud Rd NE
Calhoun, GA 30701
Phone (706) 602-7800
1514 Vernon Rd
Lagrange, GA 30240
Phone (706) 812-2369
Interoperability endpoints
- https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN220792 | GA | Yes |
Addresses
Primary practice location
1514 Vernon Rd
Lagrange, GA 30240-4131
Mailing address
10545 Summer Creek Dr
Alpharetta, GA 30022-5084
Phone (706) 631-5247
Other providers in Lagrange, GA
- Taylor Alysse Billingsley
- Elizabeth Billiter
- Kay G Birkeli
- Gary Tyrone Bishop
- Jessica Rosalie Bishop
- Blackbird Endeavors, LLC
- Joya Deneen Bland
- Julia Bradford Blanton
- Leona Lin Bleich
- Charmaine L Bliss
All providers in Lagrange, GA · Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 7, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.