Individual provider Active NPI

Brenda Leigh Trumbull, APRN

  • Adult Health Nurse Practitioner
  • Beavercreek, OH
National Provider Identifier
1457973448
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APRN.CNP.026717 Issued in OH
Practice address
4230 Research Blvd
Beavercreek, OH 45430-2204
Phone
(937) 204-1781
Fax
(937) 963-0952
NPI assigned
May 12, 2020
Last updated
Dec 6, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X APRN.CNP.026717 OH
Adult Health Nurse Practitioner 363LA2200X APRN.CNP.026717 OH Primary

Addresses

Primary practice location

4230 Research Blvd
Beavercreek, OH 45430-2204

Mailing address

6048 Boxelder Dr
Tipp City, OH 45371-7590
Phone (937) 716-8987

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20200528001448 OH Practitioner - Nurse Practitioner 6103247242 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN.CNP.026717OHMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mobile Physician Services Inc. Adult Health CurrentSince Feb 15, 2021 Accepting new patients
Healogics Specialty Physicians of Ohio, LLC PastSince May 1, 2020 Accepting new patients

Locations

6804 Cecelia Dr
New Prt Rchy, FL 34653
Phone (727) 232-0644

4031 Colonel Glenn Hwy
Ste 133
Beavercreek Township, OH 45431
Phone (800) 488-3934

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, 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": "1589241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1457973448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6048 BOXELDER DR",
            "city": "TIPP CITY",
            "state": "OH",
            "postal_code": "453717590",
            "telephone_number": "937-716-8987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4230 RESEARCH BLVD",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454302204",
            "telephone_number": "937-204-1781",
            "fax_number": "937-963-0952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRUMBULL",
        "first_name": "BRENDA",
        "middle_name": "LEIGH",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-12",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OH",
            "license": "APRN.CNP.026717",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "APRN.CNP.026717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beavercreek, OH

Sources for this page

Verify at the official NPI Registry.