Individual provider Active NPI

Brenda R. McDonnell, AU.D.

  • Audiologist-Hearing Aid Fitter
  • Tallahassee, FL
National Provider Identifier
1407016017
Registry record updated Aug 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Audiologist-Hearing Aid FitterTaxonomy code 237600000X
License
AY863 Issued in FL
Practice address
1907 Capital Cir NE
Tallahassee, FL 32308-4421
Phone
(850) 222-4434
Fax
(850) 222-4434
NPI assigned
Jun 17, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 9, 2023

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

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 1039A AL
Assistive Technology Practitioner Audiologist 231HA2400X 1039A AL
Audiologist 231H00000X AY863 FL
Assistive Technology Practitioner Audiologist 231HA2400X AY863 FL
Assistive Technology Supplier Audiologist 231HA2500X AY863 FL
Assistive Technology Supplier Audiologist 231HA2500X 1039A AL
Audiologist-Hearing Aid Fitter 237600000X 1039A AL
Audiologist-Hearing Aid Fitter 237600000X AY863 FL Primary

Addresses

Primary practice location

1907 Capital Cir NE
Tallahassee, FL 32308-4421

Mailing address

1907 Capital Cir NE
Tallahassee, FL 32308-4421
Phone (850) 222-4434

Other practice location 1

5043 Bayou Blvd
Pensacola, FL 32503-2528
Phone (850) 291-9761

Other practice location 2

602 Victoria Pl Ste B
Thomasville, GA 31792-6687
Phone (229) 227-1750

Other practice location 3

402 S West St
Bainbridge, GA 39819-3914
Phone (229) 246-5885

Other identifiers 1

IdentifierTypeStateIssuer
000825500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080903000653 FL Practitioner - Qualified Audiologist 1557437266 Reassigns benefits to 1 organization
I20150618000434 GA Practitioner - Qualified Audiologist 1557437266 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AY863FLMDAssistive Technology Practitioner Audiologist
1039AALMDAudiologist-Hearing Aid Fitter

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Speech and Hearing Specialists, Inc Audiologist PastSince Jun 24, 2008 Accepting new patients
GN Hearing Care Corp Past Accepting new patients

Organizations & group practices 3

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": "1213660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691539200000",
    "number": "1407016017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1907 CAPITAL CIR NE",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084421",
            "telephone_number": "850-222-4434",
            "fax_number": "850-222-4434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1907 CAPITAL CIR NE",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084421",
            "telephone_number": "850-222-4434",
            "fax_number": "850-222-4434"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5043 Bayou Blvd",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325032528",
            "country_code": "US",
            "telephone_number": "850-291-9761",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "602 Victoria Pl Ste B",
            "address_purpose": "LOCATION",
            "city": "Thomasville",
            "state": "GA",
            "postal_code": "317926687",
            "country_code": "US",
            "telephone_number": "229-227-1750",
            "fax_number": "850-222-4434",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "402 S West St",
            "address_purpose": "LOCATION",
            "city": "Bainbridge",
            "state": "GA",
            "postal_code": "398193914",
            "country_code": "US",
            "telephone_number": "229-246-5885",
            "fax_number": "850-222-4434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCDONNELL",
        "first_name": "BRENDA",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-17",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "AL",
            "license": "1039A",
            "primary": false
        },
        {
            "code": "231HA2400X",
            "taxonomy_group": "",
            "desc": "Audiologist, Assistive Technology Practitioner",
            "state": "AL",
            "license": "1039A",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "FL",
            "license": "AY863",
            "primary": false
        },
        {
            "code": "231HA2400X",
            "taxonomy_group": "",
            "desc": "Audiologist, Assistive Technology Practitioner",
            "state": "FL",
            "license": "AY863",
            "primary": false
        },
        {
            "code": "231HA2500X",
            "taxonomy_group": "",
            "desc": "Audiologist, Assistive Technology Supplier",
            "state": "FL",
            "license": "AY863",
            "primary": false
        },
        {
            "code": "231HA2500X",
            "taxonomy_group": "",
            "desc": "Audiologist, Assistive Technology Supplier",
            "state": "AL",
            "license": "1039A",
            "primary": false
        },
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "AL",
            "license": "1039A",
            "primary": false
        },
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "FL",
            "license": "AY863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000825500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.