Eric Lance Brandenburg, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4258 Issued in SC

Practice address

905 Verdae Blvd Ste 101
Greenville, SC 29607-4098

Phone

(864) 286-7550

Fax

(864) 286-7551

NPI assigned

Sep 28, 2016

Last updated

Dec 21, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prisma Health Urgent Care of South Carolina PCGroup PAC ID 1254703788, 158 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: ebrandenburg627656@direct.ghs.myhfn.org

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.

• Prisma Health Urgent Care of South Carolina, PC

  dba Prisma Health Urgent Care

  • Urgent Care Clinic/Center
  • Greenville, SC
  • NPI 1851000855
  Medicare reassignment Care Compare group
• The Brocedure

  • Clinic/Center
  • Greenville, SC
  • NPI 1255124020
  NPD Authorized official
• Prisma Health University Medical Group

  • Family Medicine Physician
  • Greenville, SC
  • NPI 1295763217
  Medicare reassignment
• Prisma Health University Medical Group

  dba Parkside OB-GYN

  • Gynecology Physician
  • Greer, SC
  • NPI 1003619313
  NPD
• Prisma Health University Medical Group

  dba University Medical Group/Mobile Health Clinic

  • Nurse Practitioner
  • Greenville, SC
  • NPI 1053786483
  NPD

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

{
    "created_epoch": "1475020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1659820835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 VERDAE BLVD STE 101",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296074098",
            "telephone_number": "864-286-7550",
            "fax_number": "864-286-7551"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1120 Westmoreland Ave",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132103161",
            "country_code": "US",
            "telephone_number": "315-470-7111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRANDENBURG",
        "first_name": "ERIC",
        "middle_name": "LANCE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-28",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "020218",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "4258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6063PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabrielle Bramblett, NP
• Pamela Bramlett, RPH
• Sarah Kathleen Hernstrom Bramon, AGNP
• Kemper Marion Brand II, PA
• Alexandra Zoe Brandenburg, PA-C
• Dorisann H. Brandt, PHYSICAL THERAPIST
• Timothy Brandt
• Reginald R Brannen, D.C.
• Drew R Brannon, PH.D.
• Dymia Brannon

• Physician Assistant in Greenville, SC
• Providers in Greenville, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.