Brenden G Tully, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.008422RX Issued in OH

Practice address

2420 Lake Ave
Ashtabula, OH 44004-4954

Phone

(440) 997-2262

NPI assigned

Jun 29, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bloomington Medical Services LLCGroup PAC ID 9032297627, 106 clinicians

WRH Physicians, IncGroup PAC ID 0840342366, 149 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Summa Western Reserve Hospital Hospital, Cuyahoga Falls, OH, CCN 360150

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Bloomington Medical Services LLC

  • Internal Medicine Physician
  • Wooster, OH
  • NPI 1528246683
  Medicare reassignment Care Compare group NPD
• WRH Physicians, Inc.

  • Pain Medicine Physician
  • Cuyahoga Falls, OH
  • NPI 1700025459
  Medicare reassignment Care Compare group NPD
• Emergency Professional Services, Inc.

  dba Emergency Professional Services of Ohio, Inc.

  • Emergency Medicine Physician
  • Seaman, OH
  • NPI 1093762353
  Medicare reassignment
• WRH Physicians, Inc.

  • Urgent Care Clinic/Center
  • Stow, OH
  • NPI 1295067940
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Western Reserve Hospital, LLC

  • General Acute Care Hospital
  • Cuyahoga Falls, OH
  • NPI 1518104199
  Care Compare affiliation

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

{
    "created_epoch": "1687996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1720765969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 CASTLE ROCK RD",
            "city": "BROOKFIELD",
            "state": "OH",
            "postal_code": "444038603",
            "telephone_number": "330-413-7913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 LAKE AVE",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440044954",
            "telephone_number": "440-997-2262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLY",
        "first_name": "BRENDEN",
        "middle_name": "G",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-29",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.008422RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Khanh Trinh
• Jennifer Ellen Troy, LISW
• True Sound Hearing Services
• Rachel Elizabeth Truelsch, MSSA, LISW
• Maria Trunck
• Cletus Joseph Ryan Turner
• Jailah Noelle Turner
• Uh Regional Hospitals (UH Regional Hospitals Urgent Care)
• University Hospitals Conneaut Medical Center (Uh Ashtabula Health Clinic)
• University Hospitals Geneva Medical Center (UH Geneva Urgent Care)

• Physician Assistant in Ashtabula, OH
• Providers in Ashtabula, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; 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.