Individual provider Active NPI

Jon-Michael Brunner

  • Physician Assistant
  • Wheeling, WV
National Provider Identifier
1659867216
Registry record updated Jul 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1 Medical Park
Wheeling, WV 26003-6379
Phone
(304) 243-3000
NPI assigned
Jul 7, 2018
Last updated
Jul 7, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2018

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 NU Primary

Addresses

Primary practice location

1 Medical Park
Wheeling, WV 26003-6379

Mailing address

16 Leatherwood LN Apt 4
Wheeling, WV 26003-6447
Phone (304) 312-3650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20181113003360 WV Practitioner - Physician Assistant 7719231570 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Reynolds Memorial Hospital, Inc CurrentSince Jun 1, 2022 Accepting new patients

Locations

426 8th St
Ste 101
Glen Dale, WV 26038
Phone (304) 221-4588

800 Wheeling Ave
Glen Dale, WV 26038
Phone (304) 221-4520

1 Medical Park
Wheeling, WV 26003
Phone (304) 243-3124

Interoperability endpoints

  • Direct secure messaging: jbrunner318439@direct.wvuhsdirect.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1530921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530921600000",
    "number": "1659867216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 LEATHERWOOD LN APT 4",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260036447",
            "telephone_number": "304-312-3650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260036379",
            "telephone_number": "304-243-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNNER",
        "first_name": "JON-MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-07",
        "last_updated": "2018-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheeling, WV

Sources for this page

Verify at the official NPI Registry.