Sean Francis Bray, PA-C
Individual provider Active NPI Physician Assistant · Clarksville, TN
NPI 1477594679 · NPPES record last updated Jul 21, 2011
Key facts
- NPI
- 1477594679
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 00860 (TN)
- Practice address
- 651 Dunlop LN
Clarksville, TN 37040-5015 - Phone
- (931) 502-1370
- NPI assigned
- Jun 9, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040917000308 | TN | Practitioner - Physician Assistant | 9234107392 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 860 | TN | MD | Occupational Therapist |
| 00860 | TN | MD | Physician Assistant |
| TC030 | KY | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeastern Emergency Services of Memphis, P.C. | Physician Assistant | Past | Accepting new patients |
| Magpie Emergency Physicians PLLC | Physician Assistant | Past | Accepting new patients |
| Emergency Services Network, PLLC. | Past | Accepting new patients | |
| Emergency Physicians of Hopkinsville PLLC | Past | Accepting new patients |
Interoperability endpoints
- sean.bray.1@32073.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 00860 | TN | Yes |
Addresses
Primary practice location
651 Dunlop LN
Clarksville, TN 37040-5015
Mailing address
2020 21St Ave S
Suite 201
Nashville, TN 37212-4354
Phone (615) 269-0652
NPI Registry JSON
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311206400000",
"number": "1477594679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2020 21ST AVE S",
"address_2": "SUITE 201",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372124354",
"telephone_number": "615-269-0652",
"fax_number": "615-269-0135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "651 DUNLOP LN",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370405015",
"telephone_number": "931-502-1370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAY",
"first_name": "SEAN",
"middle_name": "FRANCIS",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-09",
"last_updated": "2011-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TN",
"license": "00860",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
- Brannen & Yarbrough Family Dental Center
- James Edwards Brannen
- Billie T Brantley
- Hannah Marie Braun
- Ronald Kerry Brawley
- Breakthrough Counseling PLLC
- Lisa M Breece
- Kirsten Breedlove
- Keri Brelsford
- Cayce Brewer
All providers in Clarksville, TN · Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.