Gerald Edwin Brenneman, P.A.C.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

101469 Issued in NC

Practice address

Coats Medical Clinic
25 North Johnson St.
Coats, NC 27521

Phone

(910) 897-6423

Fax

(910) 897-2540

NPI assigned

Jul 5, 2006

Last updated

Sep 26, 2012By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348617600000",
    "number": "1649201336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 819",
            "address_2": "25 NORTH JOHNSON ST.",
            "city": "COATS",
            "state": "NC",
            "postal_code": "275210819",
            "telephone_number": "910-897-6423",
            "fax_number": "910-897-2540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "COATS MEDICAL CLINIC",
            "address_2": "25 NORTH JOHNSON ST.",
            "city": "COATS",
            "state": "NC",
            "postal_code": "27521",
            "telephone_number": "910-897-6423",
            "fax_number": "910-897-2540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNEMAN",
        "first_name": "GERALD",
        "middle_name": "EDWIN",
        "name_prefix": "Mr.",
        "credential": "P.A.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2012-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "101469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Regina Braxton Bray Brown, M.D.
• Cynthia Lonigan Burkes, P.A.
• Cape Fear Valley Health Medical Group LLC (Cape Fear Valley Primary Care Family Medicine Continuity Clinic-Coats)
• Coats Grove Fire & Rescue Inc
• Coats Medical Clinic, PA
• Coats Medical Services LLC (Cape Fear Valley Primary Care Family Medicine Continuity Clinic-Coats)

• Physician Assistant in Coats, NC
• Providers in Coats, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2012; 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.