David G Brunck, PAC
Individual provider Active NPI Physician Assistant · New Albany, IN
NPI 1730141789 · NPPES record last updated Mar 19, 2021
Key facts
- NPI
- 1730141789
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 10000682A (IN)
- Practice address
- 4101 Technology Ave
New Albany, IN 47150-8548 - Phone
- (812) 941-4500
- Fax
- (812) 542-1904
- NPI assigned
- Apr 5, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 18
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- American Health Network of Indiana LLC
Practice addresses (Care Compare)
10995 Allisonville Rd
Suite 100
Fishers, IN 46038-2616
Phone (317) 842-7928
4101 Technology Ave
New Albany, IN 47150-8548
Phone (812) 941-4500
Hospital & facility affiliations
- Baptist Health Floyd
- Physicians' Medical Center LLC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040721000466 | IN | Practitioner - Physician Assistant | 4284614348 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10000682A | IN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Health Network of Indiana, LLC | Current |
Accepting new patients | |
| Cep America LLC | Current |
Accepting new patients | |
| Cep America LLC | Current |
Accepting new patients | |
| American Health Network of Indiana LLC | Current |
Accepting new patients | |
| American Health Network of Indiana, LLC | Past | Accepting new patients | |
| Elizabethtown Emergency Physicians, LLC | Physician Assistant | Past | Accepting new patients |
| Expresscare of Southern Indiana | Past |
Accepting new patients |
Locations
1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423
10995 Allisonville Rd
Ste 100
Fishers, IN 46038
Phone (317) 842-7928
7440 Woodland Dr
Indianapolis, IN 46278
Phone (317) 450-3357
4101 Technology Ave
New Albany, IN 47150
Phone (812) 941-4500
1850 State St
New Albany, IN 47150
Phone (812) 944-7701
3897 Charlestown Rd
New Albany, IN 47150
Phone (502) 495-3665
1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523
Interoperability endpoints
- david.brunckpac.p63@direct.ahni.nextgenshare.com
- dbrunck211158@direct.optum.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10000682A | IN | Yes |
Addresses
Primary practice location
4101 Technology Ave
New Albany, IN 47150-8548
Mailing address
4101 Technology Ave
New Albany, IN 47150-8548
Phone (812) 941-4500
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | david.brunckpac.p63@direct.ahni.nextgenshare.com | Direct |
Other providers in New Albany, IN
- Jennifer L Brown
- Jordan Brokha Brown
- Shannon Michelle Brown
- Vardeet Brown
- Emily Browning
- Russell Stewart Bryan
- Alyssa Bryant
- Robin Bryant
- Carole Buhts
- Briana Bullitt
All providers in New Albany, IN · Physician Assistant in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.