Active NPI
Brianna Katherine Wall, PA
- Surgical Physician Assistant
- Harwich, MA
National Provider Identifier
1689315533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA.0009912
- Practice address
- 16 Vineyard LN
Harwich, MA 02645-2455 - Phone
- (774) 209-0612
- NPI assigned
- Apr 5, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA.0009912 | CO | Primary |
Addresses
Primary practice location
16 Vineyard LN
Harwich, MA 02645-2455
Mailing address
PO Box 110429
Aurora, CO 80042-0429
Other practice location 1
12605 E 16th Ave
Aurora, CO 80045-2520
Phone (720) 848-0000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brigham and Women'S Hospital | Current | Accepting new patients | |
| Brigham and Womens Physicians Organization Inc | Single Specialty | Past | Accepting new patients |
Locations
75 Francis St
Boston, MA 02115
Interoperability endpoints
- wall.brianna.bwh@direct.partners.masshiway.net
Organizations & group practices 3
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.
-
- Internal Medicine Physician
- Boston, MA
- NPI 1033535497
-
- General Acute Care Hospital
- Boston, MA
- NPI 1093885816
-
- Diagnostic Radiology Physician
- Boston, MA
- NPI 1265464598
Single Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786924800000",
"number": "1689315533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 110429",
"city": "AURORA",
"state": "CO",
"postal_code": "800420429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16 VINEYARD LN",
"city": "HARWICH",
"state": "MA",
"postal_code": "026452455",
"telephone_number": "774-209-0612"
}
],
"practiceLocations": [
{
"address_1": "12605 E 16th Ave",
"address_purpose": "LOCATION",
"city": "Aurora",
"state": "CO",
"postal_code": "800452520",
"country_code": "US",
"telephone_number": "720-848-0000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALL",
"first_name": "BRIANNA",
"middle_name": "KATHERINE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-05",
"last_updated": "2026-08-17",
"certification_date": "2026-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "CO",
"license": "PA.0009912",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Harwich, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; 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.