Individual provider Active NPI

Gregory T Brennan, PA-C

  • Physician Assistant
  • Boston, MA
National Provider Identifier
1629300124
Registry record updated Jan 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA4313 Issued in MA
Practice address
147 Milk St
Boston, MA 02109-4806
Phone
(617) 559-8239
Fax
(617) 421-3487
NPI assigned
Feb 8, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0758 NH
Physician Assistant 363A00000X PA4313 MA Primary

Addresses

Primary practice location

147 Milk St
Boston, MA 02109-4806

Mailing address

147 Milk St
Boston, MA 02109-4806
Phone (617) 559-8239

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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

Enrollment IDStateProvider typePAC IDDetails
I20120515000035 MA Practitioner - Physician Assistant 0941326862 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atrius Health IncGroup PAC ID 4789588641, 1,214 clinicians

Practice addresses (Care Compare)

100 2ND Ave
Needham, MA 02494-2809
Phone (781) 726-4800

133 Brookline Ave
Boston, MA 02215-3904
Phone (617) 421-1000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0758NHMDPhysical Therapy Assistant
PA4313MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Atrius Health, Inc. Physician Assistant CurrentSince Apr 1, 2012 Accepting new patients
Atrius Health, Inc. CurrentSince Apr 1, 2012 Accepting new patients

Locations

147 Milk St
Boston, MA 02109
Phone (617) 421-2508

133 Brookline Ave
Boston, MA 02215
Phone (617) 421-1000

Interoperability endpoints

  • Direct secure messaging: gbrennanpa40960@direct.atrius.masshiway.net

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1265587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326240000000",
    "number": "1629300124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 MILK ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021094806",
            "telephone_number": "617-559-8239",
            "fax_number": "617-421-3487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 MILK ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021094806",
            "telephone_number": "617-559-8239",
            "fax_number": "617-421-3487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNAN",
        "first_name": "GREGORY",
        "middle_name": "T",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-08",
        "last_updated": "2012-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NH",
            "license": "0758",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA4313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.