NPIMap

Individual provider Active NPI

Bradley Allen Irvin

  • Physician Assistant
  • Morristown, TN
National Provider Identifier
1629584917
Registry record updated Jun 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3029 Issued in SC
Practice address
4185 Willow Way
Morristown, TN 37814-1611
Phone
(423) 248-4972
NPI assigned
Dec 21, 2017
Last updated
Jun 14, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3029 SC Primary
Physician Assistant 363A00000X NU

Addresses

Primary practice location

4185 Willow Way
Morristown, TN 37814-1611

Mailing address

4185 Willow Way
Morristown, TN 37814-1611

Other practice location 1

3 Richland Medical Park Dr Ste 310
Columbia, SC 29203-6862
Phone (803) 434-8323

Other identifiers 1

IdentifierTypeStateIssuer
3749PAMedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180628001381 TN Practitioner - Physician Assistant 2668728957 Reassigns benefits to 1 organization
I20181108002275 SC Practitioner - Physician Assistant 2668728957 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cogent Healthcare of Georgia PCGroup PAC ID 2961483607, 252 clinicians
Intensive Care Consortium IncGroup PAC ID 0244269413, 485 clinicians

Practice addresses (Care Compare)

302 University Pkwy
Aiken, SC 29801-6302
Phone (803) 641-5000

9330 Medical Plaza Dr
Charleston, SC 29406-9104
Phone (843) 847-4559

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.99 of 100Reported as group
Quality
81.65
Improvement activities
40
Cost
74.65

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3510TNMDFamily Medicine Physician
3029SCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Community Physicians CurrentSince Apr 1, 2024 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Jun 12, 2023 Accepting new patients
Musc Community Physicians CurrentSince Apr 1, 2024 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Jun 12, 2023 Accepting new patients
Prisma Health Medical Group-Midlands Past Accepting new patients

Locations

302 University Pkwy
Aiken, SC 29801
Phone (803) 279-3940

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930

3 Richland Medical Park Dr
Ste 310
Columbia, SC 29203
Phone (803) 434-8323

Interoperability endpoints

  • Direct secure messaging: birvin651326@direct.ghs.myhfn.org

Organizations & group practices 12

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 5

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": "1513814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1629584917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4185 WILLOW WAY",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378141611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4185 WILLOW WAY",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378141611",
            "telephone_number": "423-248-4972"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Richland Medical Park Dr Ste 310",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292036862",
            "country_code": "US",
            "telephone_number": "803-434-8323",
            "fax_number": "803-434-8326",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IRVIN",
        "first_name": "BRADLEY",
        "middle_name": "ALLEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-21",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "3029",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3749PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morristown, TN

Sources for this page

Verify at the official NPI Registry.