NPIMap

Individual provider Active NPI

Bryant Randall Kearney, PAC

  • Surgical Physician Assistant
  • Prairie Du Sac, WI
National Provider Identifier
1366725541
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
2836-023 Issued in WI
Practice address
250 26TH St
Prairie Du Sac, WI 53578-2204
Phone
(608) 643-2471
Fax
(608) 643-4788
NPI assigned
Sep 23, 2011
Sex
Male
Sole proprietor
No

Organizations & group practices 11

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.

Hospital & facility affiliations 1

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

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Wisconsin School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sauk Prairie Healthcare Inc 122 clinicians

Practice addresses (Care Compare)

260 26TH St
Prairie Du Sac, WI 53578-2203
Phone (608) 643-7574

Hospital & facility affiliations

  • Sauk Prairie Hospital Hospital, Prairie Du Sac, WI, CCN 520095

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20111122000815 WI Practitioner - Physician Assistant 8527232883 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2836-023WIMDSurgical Physician Assistant
2836WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sauk Prairie Healthcare Inc CurrentSince Jun 6, 2016 Accepting new patients
Sauk Prairie Healthcare, Inc. CurrentSince Jun 6, 2016 Accepting new patients
Sauk Prairie Healthcare Inc Current Accepting new patients
Sauk Prairie Healthcare Inc Past Accepting new patients

Locations

250 26th St
Prairie du Sac, WI 53578
Phone (608) 643-2431

260 26th St
Prairie du Sac, WI 53578
Phone (608) 643-2471

Interoperability endpoints

  • Direct secure messaging: bryant.kearney@direct.saukprairiehealthcare.org
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: bkearney@oasp1875.srs-direct.com

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2836-023 WI
Surgical Physician Assistant 363AS0400X 2836-023 WI Primary

Addresses

Primary practice location

250 26TH St
Prairie Du Sac, WI 53578-2204

Mailing address

250 26TH St
Prairie Du Sac, WI 53578-2204
Phone (608) 643-2471

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bkearney@OASP1875.srs-direct.com

NPI Registry JSON

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

{
    "created_epoch": "1316736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618444800000",
    "number": "1366725541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 26TH ST",
            "city": "PRAIRIE DU SAC",
            "state": "WI",
            "postal_code": "535782204",
            "telephone_number": "608-643-2471",
            "fax_number": "608-643-4788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 26TH ST",
            "city": "PRAIRIE DU SAC",
            "state": "WI",
            "postal_code": "535782204",
            "telephone_number": "608-643-2471",
            "fax_number": "608-643-4788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEARNEY",
        "first_name": "BRYANT",
        "middle_name": "RANDALL",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-23",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "2836-023",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WI",
            "license": "2836-023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bkearney@OASP1875.srs-direct.com",
            "affiliation": "N",
            "address_1": "250 26th St",
            "city": "Prairie Du Sac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535782204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Prairie Du Sac, WI

Sources for this page

Verify at the official NPI Registry.