NPIMap

Individual provider Active NPI

Brandi Selina Queen, FNP

  • Family Nurse Practitioner
  • Marshville, NC
National Provider Identifier
1558670604
Registry record updated Jan 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5004900 Issued in NC
Practice address
520 W Main St
Marshville, NC 28103-1197
Phone
(704) 624-3388
Fax
(704) 624-3390
NPI assigned
Oct 6, 2010
Last updated
Jan 28, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5004900 NC Primary

Addresses

Primary practice location

520 W Main St
Marshville, NC 28103-1197

Mailing address

520 W Main St
Marshville, NC 28103-1197
Phone (704) 624-3388

Other identifiers 1

IdentifierTypeStateIssuer
7005602MedicaidNC

Other names 1

  • Brandi Selina Thomas Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101116000689 NC Practitioner - Nurse Practitioner 2769677723 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Medical, P.a.Group PAC ID 7719204775, 3 clinicians

Practice addresses (Care Compare)

520 W Main St
Marshville, NC 28103-1197
Phone (704) 624-3388

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical, P.a. CurrentSince Jan 1, 2017 Accepting new patients
Physicians Eldercare PA Past Accepting new patients

Locations

520 W Main St
Marshville, NC 28103
Phone (704) 624-3388

Interoperability endpoints

  • Direct secure messaging: brandi.queen.1@27335.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/27335/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 2

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1286323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548633600000",
    "number": "1558670604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 W MAIN ST",
            "city": "MARSHVILLE",
            "state": "NC",
            "postal_code": "281031197",
            "telephone_number": "704-624-3388",
            "fax_number": "704-624-3390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 W MAIN ST",
            "city": "MARSHVILLE",
            "state": "NC",
            "postal_code": "281031197",
            "telephone_number": "704-624-3388",
            "fax_number": "704-624-3390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEEN",
        "first_name": "BRANDI",
        "middle_name": "SELINA",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-06",
        "last_updated": "2019-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5004900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7005602",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRANDI",
            "last_name": "THOMAS",
            "middle_name": "SELINA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Marshville, NC

Sources for this page

Verify at the official NPI Registry.