Individual provider Active NPI

Brynn Nicole McKeon, PA-C

  • Medical Physician Assistant
  • Monticello, NY
National Provider Identifier
1669929899
Registry record updated Sep 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
020076 Issued in NY
Practice address
38 Concord Rd
Monticello, NY 12701-3210
Phone
(845) 333-6500
Fax
(845) 333-6501
NPI assigned
Sep 6, 2016
Last updated
Sep 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 020076 NY Primary

Addresses

Primary practice location

38 Concord Rd
Monticello, NY 12701-3210

Mailing address

38 Concord Rd
Monticello, NY 12701-3210
Phone (845) 333-6500

Other practice location 1

1522 State Route 17B
White Lake, NY 12786-5428
Phone (845) 333-6600

Other names 1

  • Brynn Nicole Bertholf Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bmckeon50333@direct.garnethealth.org Garnet Health Doctors PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20181029002901 NY Practitioner - Physician Assistant 5991058596 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Garnet Health Doctors PCGroup PAC ID 8628293545, 165 clinicians
Garnet Health Urgent Care PCGroup PAC ID 5395009765, 21 clinicians

Practice addresses (Care Compare)

36 Pearl St
Livingston Manor, NY 12758-5148
Phone (845) 439-3579

38 Concord Rd
Monticello, NY 12701-3210
Phone (845) 333-6500

68 Harris Bushville Rd
Harris, NY 12742
Phone (845) 333-8909

707 E Main St
Middletown, NY 10940-2650
Phone (845) 333-7575

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
020076NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Garnet Health Doctors PC CurrentSince Mar 4, 2019 Accepting new patients

Locations

36 Pearl St
Livingston Manor, NY 12758
Phone (845) 439-3575

707 E Main St
Middletown, NY 10940
Phone (845) 333-1000

38 Concord Rd
Monticello, NY 12701
Phone (845) 333-6500

1522 State Route 17B
White Lake, NY 12786
Phone (845) 333-6600

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: bmckeon50333@direct.garnethealth.org

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.

Hospital & facility affiliations 6

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": "1473120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1669929899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 CONCORD RD",
            "city": "MONTICELLO",
            "state": "NY",
            "postal_code": "127013210",
            "telephone_number": "845-333-6500",
            "fax_number": "845-333-6501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 CONCORD RD",
            "city": "MONTICELLO",
            "state": "NY",
            "postal_code": "127013210",
            "telephone_number": "845-333-6500",
            "fax_number": "845-333-6501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1522 State Route 17B",
            "address_purpose": "LOCATION",
            "city": "White Lake",
            "state": "NY",
            "postal_code": "127865428",
            "country_code": "US",
            "telephone_number": "845-333-6600",
            "fax_number": "845-583-8084",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKEON",
        "first_name": "BRYNN",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-06",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "020076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bmckeon50333@direct.garnethealth.org",
            "affiliation": "Y",
            "affiliationName": "Garnet Health Doctors PC",
            "address_1": "1522 State Route 17B",
            "city": "White Lake",
            "state": "NY",
            "country_code": "US",
            "postal_code": "127865428",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "BRYNN",
            "last_name": "BERTHOLF",
            "middle_name": "NICOLE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Monticello, NY

Sources for this page

Verify at the official NPI Registry.