NPIMap

Individual provider Active NPI

Brian W Hawthorne, M.D.

  • Family Medicine Physician
  • Indiana, PA
National Provider Identifier
1396726337
Registry record updated Feb 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD061667L Issued in PA
Practice address
50 Merrick St
Indiana, PA 15701-8988
Phone
(304) 276-1578
NPI assigned
Nov 8, 2005
Last updated
Feb 10, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 19027 WV
Family Medicine Physician 207Q00000X MD061667L PA Primary

Addresses

Primary practice location

50 Merrick St
Indiana, PA 15701-8988

Mailing address

50 Merrick St
Indiana, PA 15701-8988
Phone (304) 276-1578

Other identifiers 4

IdentifierTypeStateIssuer
1802281000MedicaidWV
001709238OtherWVGROUP BLUE SHIELD #
3810002243MedicaidWV
001718039OtherWVIND BLUE SHIELD #

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
I20210914003336 SC Practitioner - Family Practice 1153363395 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

300 Singleton Ridge Rd
Conway, SC 29526-9142
Phone (843) 347-7111

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD061667LPAMDFamily Medicine Physician
19027WVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Conway Hospital, Inc. Past Accepting new patients

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 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1396726337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 MERRICK ST",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157018988",
            "telephone_number": "304-276-1578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 MERRICK ST",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157018988",
            "telephone_number": "304-276-1578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAWTHORNE",
        "first_name": "BRIAN",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "19027",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD061667L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1802281000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BLUE SHIELD #",
            "identifier": "001709238",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810002243",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IND BLUE SHIELD #",
            "identifier": "001718039",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indiana, PA

Sources for this page

Verify at the official NPI Registry.