Alan Bart Brackup, M.D.

Primary specialty

Ophthalmic Plastic and Reconstructive Surgery PhysicianTaxonomy code 207WX0200X

License

MD044284E Issued in PA

Practice address

1717 Langhorne Newtown Rd Ste 150
Langhorne, PA 19047-1089

Phone

(215) 750-9400

Fax

(215) 750-7400

NPI assigned

Sep 4, 2006

Last updated

Mar 25, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Previously, effective Oct 1, 2022 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Eye and Facial Plastic Surgery Consultants LLC

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Langhorne, PA
  • NPI 1609353291
  NPD Authorized official
• Cosmetic Surgery Specialists

  • Clinic/Center
  • Langhorne, PA
  • NPI 1568529055
  Authorized official Same address or phone

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

{
    "created_epoch": "1157328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1417059908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 LANGHORNE NEWTOWN RD",
            "address_2": "STE 150",
            "city": "LANGHORNE",
            "state": "PA",
            "postal_code": "190471089",
            "telephone_number": "215-750-9400",
            "fax_number": "215-750-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 LANGHORNE NEWTOWN RD STE 150",
            "city": "LANGHORNE",
            "state": "PA",
            "postal_code": "190471089",
            "telephone_number": "215-750-9400",
            "fax_number": "215-750-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACKUP",
        "first_name": "ALAN",
        "middle_name": "BART",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-04",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD044284E",
            "primary": false
        },
        {
            "code": "207WX0200X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "PA",
            "license": "MD044284E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "4122424",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PABS (HIGHMARK)",
            "identifier": "0520626",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "E20626",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "2265859",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE",
            "identifier": "0342693000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0790237",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CHOICE",
            "identifier": "520626",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Bordeaux
• Jacqueline M Borman, PT
• Bernadett Boronea-Almasi, PHARMD
• Bowers Rehabilitation Services
• Scott Bracken, PA-C
• Brad S Friedmann
• Cassidy Brooke Bradley, BCBA
• Erin Brady
• John Michael Brady, DPT
• Thomas Andrew Brantley, LPC

• Ophthalmic Plastic and Reconstructive Surgery Physician in Langhorne, PA
• Providers in Langhorne, PA by specialty
• Ophthalmic Plastic and Reconstructive Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.