Ian Luke Bryan, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2019-01984 Issued in NC

Practice address

18 Old Fish Hatchery Rd
Edenton, NC 27932-1640

Phone

(252) 484-9024

Fax

(252) 404-8424

NPI assigned

May 12, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ian.bryan.1@20247.direct.athenahealth.com
• Direct secure messaging: encpeds@direct.practicefusion.com

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.

• DLP Maria Parham Physician Practices, LLC

  • Family Medicine Physician
  • Henderson, NC
  • NPI 1215273628
  Medicare reassignment NPD
• Scotland Memorial Hospital Inc

  • Vascular Surgery Physician
  • Laurinburg, NC
  • NPI 1477791507
  Medicare reassignment NPD
• Enc Peds PLLC

  • Primary Care Clinic/Center
  • Edenton, NC
  • NPI 1518692797
  NPD Authorized official
• DLP Maria Parham Physician Practices LLC

  • Rural Health Clinic/Center
  • Henderson, NC
  • NPI 1578256749
  NPD
• DLP Maria Parham Physician Practices, LLC

  • Family Medicine Physician
  • Henderson, NC
  • NPI 1720364649
  NPD
• Scotland Memorial Hospital Inc

  • General Practice Physician
  • Laurinburg, NC
  • NPI 1518951144

  Pediatrics

  NPD
• Moye Medical Endoscopy Center LLC

  • Ambulatory Surgical Clinic/Center
  • Greenville, NC
  • NPI 1508041666
  NPD (past)

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

{
    "created_epoch": "1463011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1639525231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222B VIRGINIA RD",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279329667",
            "telephone_number": "252-484-9024",
            "fax_number": "252-404-8424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 OLD FISH HATCHERY RD",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279321640",
            "telephone_number": "252-484-9024",
            "fax_number": "252-404-8424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "IAN",
        "middle_name": "LUKE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-12",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2019-01984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "encpeds@direct.practicefusion.com",
            "affiliation": "N",
            "endpointDescription": "EHR message",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "222B Virginia Rd",
            "city": "Edenton",
            "state": "NC",
            "country_code": "US",
            "postal_code": "279329667",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elizabeth Spencer Brentjens, LCSW
• Mathijs Henri Brentjens, MD
• Veronica Antoinette Brentjens, MD
• Jenny Bright, PHARMD
• Britthaven of Edenton, Inc.
• Joseph Henry Bunch, MA
• Bryan C Bunn, MD
• Courtney Layne Butler, NCCPSS
• Carolina Medical & Management Consultants, PLLC
• Cheryl S Carroll, CRNA

• Pediatrics Physician in Edenton, NC
• Providers in Edenton, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.