Individual provider Active NPI

Brianna Nicole Bryan, PA

  • Physician Assistant
  • Lillington, NC
National Provider Identifier
1639767502
Registry record updated Sep 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-11523 Issued in NC
Practice address
4350 US 421 S
Lillington, NC 27546-6760
Phone
(910) 893-1210
NPI assigned
Jan 6, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2021

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 0010-11523 NC Primary

Addresses

Primary practice location

4350 US 421 S
Lillington, NC 27546-6760

Mailing address

4905 Halberd CT
Raleigh, NC 27613-6088

Other practice location 1

509 N Brightleaf Blvd
Smithfield, NC 27577-4407
Phone (919) 784-3542

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bbryan316201@direct.UNC.nchie.net Direct

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210921002413 NC Practitioner - Physician Assistant 0941607725 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Carolina MG LLCGroup PAC ID 1951828847, 723 clinicians

Practice addresses (Care Compare)

4420 Lake Boone TRL
Raleigh, NC 27607-7505

509 N Brightleaf Blvd
Smithfield, NC 27577-4407
Phone (984) 215-4000

Hospital & facility affiliations

  • Johnston Health Hospital, Smithfield, NC, CCN 340090

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-11523NCMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: bbryan316201@direct.unc.nchie.net

Organizations & group practices 1

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 1

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": "1609891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632787200000",
    "number": "1639767502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4905 HALBERD CT",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276136088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 US 421 S",
            "city": "LILLINGTON",
            "state": "NC",
            "postal_code": "275466760",
            "telephone_number": "910-893-1210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "509 N Brightleaf Blvd",
            "address_purpose": "LOCATION",
            "city": "Smithfield",
            "state": "NC",
            "postal_code": "275774407",
            "country_code": "US",
            "telephone_number": "919-784-3542",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "BRIANNA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-06",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-11523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bbryan316201@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "509 N Brightleaf Blvd",
            "city": "Smithfield",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275774407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lillington, NC

Sources for this page

Verify at the official NPI Registry.