NPIMap

Individual provider Active NPI

Adam W Bruckner, D.O.

  • Family Medicine Physician
  • Aiken, SC
National Provider Identifier
1316109564
Registry record updated Feb 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1639 Issued in SC
Practice address
420 Society Hill Dr
Suite 200
Aiken, SC 29803-1731
Phone
(803) 649-7266
Fax
(803) 649-7158
NPI assigned
Jun 30, 2008
Last updated
Feb 23, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1639 SC Primary

Addresses

Primary practice location

420 Society Hill Dr
Suite 200
Aiken, SC 29803-1731

Mailing address

367 S. Gulph Rd
Att: Ipm Credentialing
King of Prussia, PA 19406-3121
Phone (803) 649-7266

Other practice location 1

110 Sasanqua Drive
Graniteville, SC 29829-4136
Phone (803) 392-1811

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130129000155 SC Practitioner - Family Practice 4486808417 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

110 Sasanqua Dr
Graniteville, SC 29829-4136
Phone (803) 594-2272

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
1639SCMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Aiken Professional Association LLC Family Medicine CurrentSince Nov 28, 2012 Accepting new patients
Aiken Professional Association, LLC Family Medicine CurrentSince Nov 28, 2012 Accepting new patients

Locations

367 S Gulph Rd
Kng of Prussa, PA 19406
Phone (610) 382-4422

137 Miracle Dr
Aiken, SC 29801
Phone (803) 226-0589

420 Society Hill Dr
#200
Aiken, SC 29803
Phone (803) 649-7266

110 Sasanqua Dr
Graniteville, SC 29829
Phone (803) 392-1811

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550880000000",
    "number": "1316109564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 S. GULPH RD",
            "address_2": "ATT: IPM CREDENTIALING",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194063121",
            "telephone_number": "803-649-7266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 SOCIETY HILL DR",
            "address_2": "SUITE 200",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298031731",
            "telephone_number": "803-649-7266",
            "fax_number": "803-649-7158"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 Sasanqua Drive",
            "address_purpose": "LOCATION",
            "city": "Graniteville",
            "state": "SC",
            "postal_code": "298294136",
            "country_code": "US",
            "telephone_number": "803-392-1811",
            "fax_number": "803-761-6247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUCKNER",
        "first_name": "ADAM",
        "middle_name": "W",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-30",
        "last_updated": "2019-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "1639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aiken, SC

Sources for this page

Verify at the official NPI Registry.