Braelen Dawn Ivicevich, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

6560 Fannin
Scurlock Tower, Suite 2200
Houston, TX 77030

Phone

(281) 737-4560

Fax

(281) 737-4561

NPI assigned

Oct 26, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

TMH Physicians and Surgeons, PLLCGroup PAC ID 1557586070, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Houston Methodist Hospital Hospital, Houston, TX, CCN 450358

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: bsvoboda21008@directhoustonmethodist.org

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.

• TMH Physicians and Surgeons, PLLC

  dba TMHPO Institute for Reconstructive Surgery

  • Plastic and Reconstructive Surgery Physician
  • Houston, TX
  • NPI 1669894796
  Medicare reassignment Care Compare group

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

• The Methodist Hospital

  dba Houston Methodist Hospital

  • General Acute Care Hospital
  • Houston, TX
  • NPI 1548387418
  Care Compare affiliation

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

{
    "created_epoch": "1445817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633564800000",
    "number": "1568834893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6560 FANNIN, SCURLOCK TOWER",
            "address_2": "SUITE 2200",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77030",
            "telephone_number": "281-737-4560",
            "fax_number": "281-737-4561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6560 FANNIN",
            "address_2": "SCURLOCK TOWER, SUITE 2200",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77030",
            "telephone_number": "281-737-4560",
            "fax_number": "281-737-4561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVICEVICH",
        "first_name": "BRAELEN",
        "middle_name": "DAWN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-26",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8266NT",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1568834893",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "281-737-4560",
            "affiliation": "N",
            "endpointDescription": "phone number",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "none",
            "address_1": "6560 Fannin",
            "address_2": "Scurlock Tower, Suite 2200",
            "city": "Houston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "77030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elizabeth Ivey
• Heather R Ivey, ASSOCIATES
• Richard Todd Ivey, MD
• Shanae Lester Ivey, PA-C
• Ivian Care Inc
• Shawna Renee Ivins, FNP-C
• Ivor W Foox MD PA
• Ivory Family Health & Wellness Clinic Inc
• Ivory Legacy Transit LLC
• Cheryl Ivory, M.A.,, L.P.C.-S

• Surgical Physician Assistant in Houston, TX
• Providers in Houston, TX by specialty
• Surgical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; 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.