Individual provider Active NPI

Brent William Porter, OTR/L

  • Occupational Therapist
  • Cornelius, NC
National Provider Identifier
1336777846
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
8994 Issued in NC
Practice address
9624 Bailey Rd Ste 273
Cornelius, NC 28031-6120
Phone
(803) 329-9500
Fax
(803) 228-0101
NPI assigned
Mar 30, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 6823 SC
Occupational Therapist 225X00000X 8994 NC Primary

Addresses

Primary practice location

9624 Bailey Rd Ste 273
Cornelius, NC 28031-6120

Mailing address

14311 Reese Blvd W Ste A2
Huntersville, NC 28078-7955
Phone (704) 980-0680

Other practice location 1

1612 Ebenezer Rd Ste 101
Rock Hill, SC 29732-3862
Phone (803) 329-9500

Other practice location 2

13835 Boren St
Huntersville, NC 28078-6476
Phone (704) 912-2222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201228000067 NC Practitioner - Occupational Therapist in Private Practice 5698187235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thrive Now TherapyGroup PAC ID 6103237003, 2 clinicians

Practice addresses (Care Compare)

Cornelius, NC 28031
Phone (704) 980-0680

9873 Shearwater Ave NW
Concord, NC 28027-8006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8994NCMDGeneral Practice Dentistry
6823SCMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Now Therapy Occupational Therapist CurrentSince Aug 18, 2020 Accepting new patients
Therapy World Occupational Therapist Current Accepting new patients

Locations

14311 Reese Blvd W
Ste A2
Huntersville, NC 28078

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1336777846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14311 REESE BLVD W STE A2",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787955",
            "telephone_number": "704-980-0680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9624 BAILEY RD STE 273",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280316120",
            "telephone_number": "803-329-9500",
            "fax_number": "803-228-0101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1612 Ebenezer Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Rock Hill",
            "state": "SC",
            "postal_code": "297323862",
            "country_code": "US",
            "telephone_number": "803-329-9500",
            "fax_number": "803-228-0101",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13835 Boren St",
            "address_purpose": "LOCATION",
            "city": "Huntersville",
            "state": "NC",
            "postal_code": "280786476",
            "country_code": "US",
            "telephone_number": "704-912-2222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PORTER",
        "first_name": "BRENT",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-30",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "SC",
            "license": "6823",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NC",
            "license": "8994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cornelius, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.