Individual provider Active NPI

Brandon Terry Craig, PA

  • Physician Assistant
  • Fullerton, CA
National Provider Identifier
1306562111
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2575 Yorba Linda Blvd
Fullerton, CA 92831-1615
Phone
(714) 449-7400
NPI assigned
Oct 13, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

2575 Yorba Linda Blvd
Fullerton, CA 92831-1615

Mailing address

2575 Yorba Linda Blvd
Fullerton, CA 92831-1615
Phone (714) 449-7400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20240123002327 CA Order and Referring Only - Physician Assistant 3173975372

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Baby Buddies Birth Center Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8237/brand/1/csg/1/fhir/r4

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.

NPI Registry JSON

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

{
    "created_epoch": "1665619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665619200000",
    "number": "1306562111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 YORBA LINDA BLVD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928311615",
            "telephone_number": "714-449-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2575 YORBA LINDA BLVD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928311615",
            "telephone_number": "714-449-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAIG",
        "first_name": "BRANDON",
        "middle_name": "TERRY",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-10-13",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.