Individual provider Active NPI

Jacob Daniel Brannen, PA-C

  • Physician Assistant
  • Roanoke, VA
National Provider Identifier
1629315460
Registry record updated Aug 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110004124 Issued in VA
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

Updated by the provider on Aug 1, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 CorporationGroup PAC ID 5890607253, 540 clinicians

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 Hospital, Roanoke, VA, CCN 490024
  • Carilion Franklin Memorial Hospital Hospital, Rocky Mount, VA, CCN 490089

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0110004124VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Healthcare Corporation CurrentSince Jul 23, 2018 Accepting new patients
Carilion Healthcare Corporation CurrentSince Jul 23, 2018 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

  • Direct secure messaging: 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.

Hospital & facility affiliations 2

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": "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

Verify at the official NPI Registry.