Ilene Brackin, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

310 N 10TH St
Bismarck, ND 58501-4516

Phone

(701) 530-7500

Fax

(701) 530-7484

NPI assigned

Sep 24, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

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: No

Green means eligible to order or refer.

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Essentia Health Hospital, Fargo, ND, CCN 350070
• Essentia Health St Marys - Detroit Lakes Hospital, Detroit Lakes, MN, CCN 240101

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: ibrackin128416@achce.catholichealth.net

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.

• Altru Health System

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1043309552
  NPD (past)
• Missouri Basin Anesthesia, PLLC

  • Anesthesiology Physician
  • Bismarck, ND
  • NPI 1952413585
  NPD (past)
• St. Alexius Heart & Lung Clinic, LLC

  • Cardiovascular Disease Physician
  • Bismarck, ND
  • NPI 1194823021
  NPD (past)
• Community Memorial Hospital

  • Internal Medicine Physician
  • Hamilton, NY
  • NPI 1932100393
  NPD (past)

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

• Innovis Health, LLC

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1215125463
  Care Compare affiliation
• St Mary'S Regional Health Center

  • Rural Health Clinic/Center
  • Frazee, MN
  • NPI 1902364482

  Hospital

  Care Compare affiliation
• St Marys Regional Health Center

  • Rural Health Clinic/Center
  • Park Rapids, MN
  • NPI 1730706656

  Hospital

  Care Compare affiliation
• St. Marys Regional Health Center

  • Rural Acute Care Hospital
  • Detroit Lakes, MN
  • NPI 1679561088
  Care Compare affiliation

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

{
    "created_epoch": "1159056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1457451981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 N 10TH ST",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014516",
            "telephone_number": "701-530-7500",
            "fax_number": "701-530-7484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 N 10TH ST",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014516",
            "telephone_number": "701-530-7500",
            "fax_number": "701-530-7484"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 3rd Ave SW",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587013880",
            "country_code": "US",
            "telephone_number": "701-857-3655",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2305 37th Ave SW",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587017669",
            "country_code": "US",
            "telephone_number": "701-857-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRACKIN",
        "first_name": "ILENE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-24",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0236",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "ND",
            "license": "PAC0236",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00210194",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1457451981",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah Boyko, FNP
• Kimber M Boyko, M.D.
• Tayon Mia Braaflat, MS, OTR/L
• Amanda Susan Braaten, M.D.
• Ashley Braaten
• Edward James Bracklin Jr.
• Nicholas Coren Bradbury, M.D.
• Douglas Bradford
• Mary Bradford
• Bradley Gynecology, P.C.

• Surgical Physician Assistant in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Surgical Physician Assistant in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.