Active NPI
Gary T Brotherson MD Inc
- Ophthalmology Physician
- Erie, PA
National Provider Identifier
1497788087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- MD030604E
- Legal business name
- GARY T BROTHERSON MD INC
- Practice address
- 1801 W 8TH St
Erie, PA 16505-4938 - Phone
- (814) 455-8004
- Fax
- (814) 456-6054
- NPI assigned
- Jul 8, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Lori Piscitelli
- Title
- Billing Admin.
- Phone
- (814) 455-8004
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | MD030604E | PA | Primary |
| Ophthalmology Physician | 207W00000X | OS010267L | PA |
Addresses
Primary practice location
1801 W 8TH St
Erie, PA 16505-4938
Mailing address
1801 W 8TH St
Erie, PA 16505-4938
Phone (814) 455-8004
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 071671 | Other | PA | BROTHERSON |
| 060638 | Other | PA | PTAN |
| 062849 | Other | PA | FATICA |
| 1011674140001 | Medicaid | PA | |
| 1444836 | Other | PA | HIGHMARK MEDICAL GTB/FAF |
| 1932173754 | Other | PA | BROTHERSON NPI |
| MD030604E | Other | PA | BROTHERSON LICENSE |
| OS010267L | Other | PA | FATICA LICENSE |
| 0009730980001 | Medicaid | PA | |
| 1821062662 | Other | PA | FATICA NPI |
Other names 1
- Niagara Eye Associates
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Gary T Brotherson MD Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- Erie, PA
- NPI 1801818810
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Ophthalmology Physician
- Erie, PA
- NPI 1932173754
-
- Optometrist
- Erie, PA
- NPI 1942274691
-
- Ophthalmology Physician
- Erie, PA
- NPI 1821062662
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152316800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1295568000000",
"number": "1497788087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1801 W 8TH ST",
"city": "ERIE",
"state": "PA",
"postal_code": "165054938",
"telephone_number": "814-455-8004",
"fax_number": "814-456-6054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 W 8TH ST",
"city": "ERIE",
"state": "PA",
"postal_code": "165054938",
"telephone_number": "814-455-8004",
"fax_number": "814-456-6054"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GARY T BROTHERSON MD INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-08",
"last_updated": "2011-01-21",
"status": "A",
"authorized_official_last_name": "PISCITELLI",
"authorized_official_first_name": "LORI",
"authorized_official_title_or_position": "BILLING ADMIN.",
"authorized_official_telephone_number": "814-455-8004",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Ophthalmology",
"state": "PA",
"license": "MD030604E",
"primary": true
},
{
"code": "207W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Ophthalmology",
"state": "PA",
"license": "OS010267L",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BROTHERSON",
"identifier": "071671",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "060638",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FATICA",
"identifier": "062849",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1011674140001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK MEDICAL GTB/FAF",
"identifier": "1444836",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BROTHERSON NPI",
"identifier": "1932173754",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BROTHERSON LICENSE",
"identifier": "MD030604E",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FATICA LICENSE",
"identifier": "OS010267L",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0009730980001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FATICA NPI",
"identifier": "1821062662",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Niagara Eye Associates",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.