Individual provider Active NPI

Brannon F. Puett, PA-C

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1407395056
Registry record updated Dec 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-06986 Issued in NC
Practice address
2630 East Seventh Street
Suite 200
Charlotte, NC 28204
Phone
(704) 364-6110
Fax
(704) 364-4245
NPI assigned
Feb 15, 2017
Last updated
Dec 21, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-06986 NC Primary

Addresses

Primary practice location

2630 East Seventh Street
Suite 200
Charlotte, NC 28204

Mailing address

2630 East Seventh Street
Suite 200
Charlotte, NC 28204
Phone (704) 364-6110

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20170502001838 NC Practitioner - Physician Assistant 1759668668 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Metrolina Dermatology and Skin Surgery Specialists PLLCGroup PAC ID 3173891892, 39 clinicians

Practice addresses (Care Compare)

10502 Park Rd
Suite 100
Charlotte, NC 28210-6569
Phone (980) 299-3926

11840 Southmore Dr
Suite 170
Charlotte, NC 28277-0792
Phone (704) 364-6110

1238 Mann Dr
Matthews, NC 28105-5539
Phone (704) 364-6110

2630 E 7TH St
Suite 200
Charlotte, NC 28204-4319
Phone (704) 364-6110

Merit-based Incentive Payment System (MIPS)

Final score
84.08 of 100Reported as group
Quality
81.28
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc CurrentSince Mar 27, 2017 Accepting new patients
Charlotte Dermatology PA CurrentSince Jan 21, 2018 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Mar 27, 2017 Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

11840 Southmore Dr
Ste 170
Charlotte, NC 28277

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

2630 E 7th St
Ste 200
Charlotte, NC 28204
Phone (704) 927-6166

5717 Albemarle Rd
Charlotte, NC 28212
Phone (704) 563-2150

9332 S Tryon St
Charlotte, NC 28273
Phone (704) 587-6700

270 Copperfield Blvd NE
Ste 102
Concord, NC 28025
Phone (704) 403-3543

1238 Mann Dr
Matthews, NC 28105
Phone (704) 771-1714

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1487116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545350400000",
    "number": "1407395056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630 EAST SEVENTH STREET",
            "address_2": "SUITE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28204",
            "telephone_number": "704-364-6110",
            "fax_number": "704-364-4245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 EAST SEVENTH STREET",
            "address_2": "SUITE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28204",
            "telephone_number": "704-364-6110",
            "fax_number": "704-364-4245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUETT",
        "first_name": "BRANNON",
        "middle_name": "F.",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-15",
        "last_updated": "2018-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.