Breanna Larae Damron, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

50.007373RX Issued in OH

Practice address

Envision Physician Services
1805 27TH St
Portsmouth, OH 45662

Phone

(740) 356-5000

NPI assigned

Sep 14, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Epmg of Ohio Inc P a

  • Emergency Medicine Physician
  • Portsmouth, OH
  • NPI 1841232196
  Medicare reassignment

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

{
    "created_epoch": "1600041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696550400000",
    "number": "1568077808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 S CALUMET DR",
            "city": "WORTHINGTON",
            "state": "KY",
            "postal_code": "411839614",
            "telephone_number": "606-547-5595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ENVISION PHYSICIAN SERVICES",
            "address_2": "1805 27TH ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "45662",
            "telephone_number": "740-356-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1128 Ramey Ave",
            "address_purpose": "LOCATION",
            "city": "Worthington",
            "state": "KY",
            "postal_code": "411839229",
            "country_code": "US",
            "telephone_number": "606-547-5595",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAMRON",
        "first_name": "BREANNA",
        "middle_name": "LARAE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-14",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OH",
            "license": "50.007373RX",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "TC031",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "TC031",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KY",
            "license": "TC031",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Cyrus, CDCA
• Kristi Cyrus
• Lynda Dadosky, CDCA
• Cheryl Ann Dahlstroem, RN, BSN, NP-C, A-GNP
• Angela Dee Dalton, LPN
• Bryan Damron, CDCA
• Cassandra Damron
• Susan Daniele
• April Daniels
• Brea Star Daniels, BSW

• Medical Physician Assistant in Portsmouth, OH
• Providers in Portsmouth, OH by specialty
• Medical Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.