Bryan Rafferty, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2881 Issued in TN

Practice address

88MDG/SGGP
4881 Sugar Maple Dr
Wpafb, OH 45433

Phone

(937) 713-9011

NPI assigned

Oct 21, 2015

Sex

Male

Sole proprietor

No

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

Enrolled in TN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: brian.rafferty@sccdc.gadirect.net

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.

• Covenant Medical Group, Inc.

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1457302010

  Physician Assistant, TN

  Medicare reassignment NPD
• Chattanooga Hamilton County Hospital Authority

  • Internal Medicine Physician
  • Chattanooga, TN
  • NPI 1154751931

  TN

  Medicare reassignment
• Chattanooga Hamilton County Hospital Authority

  • Medicare Defined Swing Bed Hospital Unit
  • Pikeville, TN
  • NPI 1073622007
  NPD
• Chattanooga Hamilton County Hospital Authority

  • Federally Qualified Health Center (FQHC)
  • Chattanooga, TN
  • NPI 1609961549
  NPD
• Covenant Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Knoxville, TN
  • NPI 1871269415
  NPD
• Skin Cancer & Cosmetic Dermatology Center, PC

  • Dermatology Physician
  • Dalton, GA
  • NPI 1376605394
  NPD

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

{
    "created_epoch": "1445385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655424000000",
    "number": "1326410044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88MDG/SGGP",
            "address_2": "4881 SUGAR MAPLE DR",
            "city": "WPAFB",
            "state": "OH",
            "postal_code": "45433",
            "telephone_number": "937-713-9011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88MDG/SGGP",
            "address_2": "4881 SUGAR MAPLE DR",
            "city": "WPAFB",
            "state": "OH",
            "postal_code": "45433",
            "telephone_number": "937-713-9011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 McFarland St",
            "address_purpose": "LOCATION",
            "city": "Morristown",
            "state": "TN",
            "postal_code": "378143977",
            "country_code": "US",
            "telephone_number": "423-581-6084",
            "fax_number": "423-581-6078",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAFFERTY",
        "first_name": "BRYAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-21",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "2881",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q019535",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tyler L Pierce, MD
• Jessica Porcelan, MD
• Susan Porter, M.D.
• Michelle L Price, PHARMD
• Paul Puchta, M.D.
• Jacob Rathmacher, DO
• Mario Luis Recupido III
• Kristen Redd, LSW
• Michael Ryan Rediske, D.D.S.
• Megan L Reeves, LISW

• All providers in Wpafb, OH
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.