NPIMap

Individual provider Active NPI

Brian Micheal Bantum, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Sparks, NV
National Provider Identifier
1578735999
Registry record updated May 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
14341 Issued in NV
Practice address
1055 Roberta LN
#103
Sparks, NV 89431-2809
Phone
(775) 331-2600
Fax
(775) 331-2605
NPI assigned
Mar 25, 2008
Last updated
May 1, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X PAPERWORK IN PROCESS NV
Physical Medicine & Rehabilitation Physician 208100000X 14341 NV Primary

Addresses

Primary practice location

1055 Roberta LN
#103
Sparks, NV 89431-2809

Mailing address

1055 Roberta LN
#103
Sparks, NV 89431-2809
Phone (775) 331-2600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20120815000167 NV Practitioner - Physical Medicine and RehabilitationPractitioner - Interventional Pain Management 5496901092 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and RehabilitationAlso: Interventional Pain Management
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Robert G Berry Jr LTDGroup PAC ID 2466488903, 5 clinicians

Practice addresses (Care Compare)

6630 S McCarran Blvd
Suite A3
Reno, NV 89509-6136
Phone (775) 448-9422

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
PAPERWORK IN PROCESSNVMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Robert G Berry Jr LTD Physical Medicine & Rehabilitation CurrentSince Aug 1, 2020 Accepting new patients
Renown Regional Medical Center Past Accepting new patients
Sparks Family Hospital Inc Past Accepting new patients
Prime Healthcare Services - Reno LLC Past Accepting new patients
Mt Grant General Hospital Past Accepting new patients

Locations

6630 S McCarran Blvd
Ste A3
Reno, NV 89509
Phone (775) 448-9422

Interoperability endpoints

  • Direct secure messaging: orthorehabofnevada.brianbantum@141557.advancedmd-direct.com

Organizations & group practices 5

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 10

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

NPI Registry JSON

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

{
    "created_epoch": "1206403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525132800000",
    "number": "1578735999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 ROBERTA LN",
            "address_2": "#103",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894312809",
            "telephone_number": "775-331-2600",
            "fax_number": "775-331-2605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 ROBERTA LN",
            "address_2": "#103",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894312809",
            "telephone_number": "775-331-2600",
            "fax_number": "775-331-2605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANTUM",
        "first_name": "BRIAN",
        "middle_name": "MICHEAL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-25",
        "last_updated": "2018-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NV",
            "license": "PAPERWORK IN PROCESS",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NV",
            "license": "14341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sparks, NV

Sources for this page

Verify at the official NPI Registry.