Bralyn Bennett Jr., PA-C

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

3837 Issued in SC

Practice address

5046 Highway 17 Byp S Ste 200
Myrtle Beach, SC 29588-4503

Phone

(843) 839-3501

NPI assigned

Jul 29, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Waccamaw Dermatology, LLC

  • Dermatology Physician
  • Myrtle Beach, SC
  • NPI 1962449181

  SC

  Medicare reassignment Care Compare group
• Coastal Kidney Center PA

  • Nephrology Physician
  • Conway, SC
  • NPI 1801961537
  NPD (past)

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Waccamaw Dermatology LLC 26 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

90.01 of 100Reported as group

Quality

100

Improvement activities

40

Cost

66.69

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

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1669145249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 ROURK ST STE 100",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724127",
            "telephone_number": "843-449-0453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5046 HIGHWAY 17 BYP S STE 200",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295884503",
            "telephone_number": "843-839-3501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8170 Rourk St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295724127",
            "country_code": "US",
            "telephone_number": "843-449-0453",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "BRALYN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-29",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "3837",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "SC",
            "license": "3837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosa Benetatos, LPC/A
• Antonio Benevento
• Benjamin J Bittner OD Inc
• Jeff A Benjamin, DO
• Austin Hunter Bennett, MD
• Jon Michael Bennett, DO
• Jonathan Antonio Bennett Jr., MA, LPC-A
• Micah Raven Bennett, FNP
• Abbey Bensing
• Erika Benson-Levy

• All providers in Myrtle Beach, SC
• Dermatology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.
• 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.