Bruce Alan Cavanaugh, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

C002022 Issued in MD

Practice address

9987 Village Green Dr
Woodstock, MD 21163-1155

Phone

(443) 570-2782

Fax

(443) 570-2782

NPI assigned

Mar 21, 2006

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 MD, DC2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Della Behavioral Health Services

  • Psychologist
  • Columbia, MD
  • NPI 1750635207

  DC

  Medicare reassignment
• Hope Psych Services LLC

  • Psychiatry Physician
  • Arnold, MD
  • NPI 1750940581

  DC

  Medicare reassignment
• Franklin Square Hospital Center, Inc

  • General Acute Care Hospital
  • Baltimore, MD
  • NPI 1184712085
  NPD
• Northwest Hospital Center, Inc.

  • Acute Care Nurse Practitioner
  • Randallstown, MD
  • NPI 1235669599
  NPD

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

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460505600000",
    "number": "1689633414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9987 VILLAGE GREEN DR",
            "city": "WOODSTOCK",
            "state": "MD",
            "postal_code": "211631155",
            "telephone_number": "443-570-2782",
            "fax_number": "443-570-2782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9987 VILLAGE GREEN DR",
            "city": "WOODSTOCK",
            "state": "MD",
            "postal_code": "211631155",
            "telephone_number": "443-570-2782",
            "fax_number": "443-570-2782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAVANAUGH",
        "first_name": "BRUCE",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-21",
        "last_updated": "2016-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C002022",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C002022",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Faithe Maria Braznell
• Michelle Pierre Brooks, D.D.S.
• Roberta Lynn Brown, PHARM.D.
• Denise Ann Butcher, LMSW-C
• Natalie Ann Carlyle, PHARMD
• Susan S. Chicca, LCSW-C BCD
• Chiropractic & PT Center of Turf Valley, LLC
• William G Dolengo, D.C.
• Sandra English, L.AC.
• Foot Savers Inc.

• Medical Physician Assistant in Woodstock, MD
• Providers in Woodstock, MD by specialty
• Medical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2016; 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.

Verify at the official NPI Registry.