Individual provider Active NPI

Audrey Wicks Branom, PA-C

  • Physician Assistant
  • Seattle, WA
National Provider Identifier
1487055059
Registry record updated Feb 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.60595391 Issued in WA
Practice address
8810 2ND Ave NE
Seattle, WA 98115-2963
Phone
(360) 621-5562
NPI assigned
Sep 14, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 8, 2016

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 PA.60595391 WA Primary

Addresses

Primary practice location

8810 2ND Ave NE
Seattle, WA 98115-2963

Mailing address

8810 2ND Ave NE
Seattle, WA 98115-2963
Phone (360) 621-5562

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20160304000737 WA Practitioner - Physician Assistant 7719283555 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Association of University PhysiciansGroup PAC ID 0446162697, 3,484 clinicians

Practice addresses (Care Compare)

1701 Columbia Rd
Seattle, WA 98195-0001
Phone (206) 598-3100

1959 NE Pacific St
Seattle, WA 98195-0001
Phone (206) 598-4333

908 Jefferson St
Seattle, WA 98104-2433
Phone (206) 744-2020

Hospital & facility affiliations

  • Harborview Medical Center Hospital, Seattle, WA, CCN 500064
  • University of Washington Medical Ctr Hospital, Seattle, WA, CCN 500008

Merit-based Incentive Payment System (MIPS)

Final score
93.85 of 100Reported as apm
Quality
74.6
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.60595391WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Harborview Medical Center CurrentSince Feb 1, 2016 Accepting new patients
Harborview Medical Center CurrentSince Feb 1, 2016 Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

1959 NE Pacific St
Seattle, WA 98195
Phone (206) 598-4333

908 Jefferson St
Fl 5
Seattle, WA 98104
Phone (206) 744-9300

325 9th Ave
Seattle, WA 98104
Phone (206) 731-3000

Interoperability endpoints

  • Direct secure messaging: abranom59146@direct.ehre.uwmedicine.org

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1410652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454889600000",
    "number": "1487055059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8810 2ND AVE NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981152963",
            "telephone_number": "360-621-5562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8810 2ND AVE NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981152963",
            "telephone_number": "360-621-5562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANOM",
        "first_name": "AUDREY",
        "middle_name": "WICKS",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-14",
        "last_updated": "2016-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA.60595391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.