Breyocha Dewalt, NP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

34590 Issued in TN

Practice address

1211 Union Ave Ste 965
Memphis, TN 38104-6638

Phone

(901) 435-8550

Fax

(901) 478-0781

NPI assigned

Aug 30, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Breyocha Mays Former name

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Nurse Practitioner

Education

University of Tennessee, HSC, College of Medicine, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Specialty Physician Group LLCGroup PAC ID 9537291323, 101 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bdewalt23486@mlh.direct-ci.com

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.

• Specialty Physician Group LLC

  • Cardiovascular Disease Physician
  • Germantown, TN
  • NPI 1174842181

  Acute Care

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1693353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1548045263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000, DEPT 960",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381480001",
            "telephone_number": "901-758-9900",
            "fax_number": "901-752-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 UNION AVE STE 965",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381046638",
            "telephone_number": "901-435-8550",
            "fax_number": "901-478-0781"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1251 Wesley Dr Ste 153",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381166443",
            "country_code": "US",
            "telephone_number": "901-435-8550",
            "fax_number": "901-395-2621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEWALT",
        "first_name": "BREYOCHA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-30",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "TN",
            "license": "0000223825",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TN",
            "license": "34590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BREYOCHA",
            "last_name": "MAYS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Milena Devineni
• Courtney Ann Deviney
• Amy L Devore, CNM
• Devoted Hand
• Devoted Healthcare Staffing LLC
• Joseph Christopher Dewane, M.D.
• Dewitt H. King, D.D.S., P.C.
• Anita Dey, MD
• Ramasubbareddy Dhanireddy, MD
• Thirumalaivasan Dhasakeerthi, M.B.B.S

• Acute Care Nurse Practitioner in Memphis, TN
• Providers in Memphis, TN by specialty
• Acute Care Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.