Active NPI
Jacob Daniel Brannen, PA-C
- Physician Assistant
- Roanoke, VA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0110004124
- Practice address
- 3707 Brambleton Ave Ste 2
Roanoke, VA 24018 - Phone
- (540) 725-7800
- Fax
- (540) 989-6752
- NPI assigned
- Jan 14, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110004124 | VA | Primary |
Addresses
Primary practice location
3707 Brambleton Ave Ste 2
Roanoke, VA 24018
Mailing address
3707 Brambleton Ave Ste 2
Roanoke, VA 24018-3658
Phone (540) 725-7800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140909000678 | VA | Practitioner - Physician Assistant | 4082833942 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Carilion Healthcare Corporation
Practice addresses (Care Compare)
3707 Brambleton Ave SW
2 Carilion Family Medicine Brambleton
Roanoke, VA 24018-3658
Phone (540) 725-7800
6415 Peters Creek Rd
Roanoke, VA 24019-4021
Phone (703) 562-2110
Hospital & facility affiliations
- Carilion Medical Center
- Carilion Franklin Memorial Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0110004124 | VA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carilion Healthcare Corporation | Current | Accepting new patients | |
| Carilion Healthcare Corporation | Current | Accepting new patients |
Locations
3707 Brambleton Ave
Ste 2
Roanoke, VA 24018
Phone (540) 725-7800
213 S Jefferson St
Ste 625
Roanoke, VA 24011
Phone (540) 224-5677
6415 Peters Creek Rd
Roanoke, VA 24019
Phone (703) 562-2110
Interoperability endpoints
- jbrannen11307@direct.carilionclinic.org
Organizations & group practices 9
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.
-
- Durable Medical Equipment & Medical Supplies
- Blacksburg, VA
- NPI 1407667256
-
- Durable Medical Equipment & Medical Supplies
- Raphine, VA
- NPI 1245041094
-
- Durable Medical Equipment & Medical Supplies
- Lexington, VA
- NPI 1336950187
-
- Durable Medical Equipment & Medical Supplies
- Christiansburg, VA
- NPI 1417251083
-
- Durable Medical Equipment & Medical Supplies
- Christiansburg, VA
- NPI 1598576357
-
- Durable Medical Equipment & Medical Supplies
- Salem, VA
- NPI 1619788460
-
- Durable Medical Equipment & Medical Supplies
- Roanoke, VA
- NPI 1629889472
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Rocky Mount, VA
- NPI 1710970918
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533081600000",
"number": "1629315460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3707 BRAMBLETON AVE STE 2",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240183658",
"telephone_number": "540-725-7800",
"fax_number": "540-989-6752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3707 BRAMBLETON AVE STE 2",
"city": "ROANOKE",
"state": "VA",
"postal_code": "24018",
"telephone_number": "540-725-7800",
"fax_number": "540-989-6752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANNEN",
"first_name": "JACOB",
"middle_name": "DANIEL",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-01-14",
"last_updated": "2018-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110004124",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Roanoke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; 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.