Individual provider Active NPI

Bryan Lee Ishmael, MSN, APRN, FNP-C

  • Family Nurse Practitioner
  • Kerrville, TX
National Provider Identifier
1730924085
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1167768 Issued in TX
Practice address
575 Hill Country Dr Ste 101
Kerrville, TX 78028-6024
Phone
(830) 258-7090
NPI assigned
Jun 27, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1167768 TX Primary

Addresses

Primary practice location

575 Hill Country Dr Ste 101
Kerrville, TX 78028-6024

Mailing address

575 Hill Country Dr Ste 101
Kerrville, TX 78028-6024
Phone (830) 258-7090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20241120001576 TX Practitioner - Nurse Practitioner 1759816325 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Peterson Medical AssociatesGroup PAC ID 1355467887, 192 clinicians

Practice addresses (Care Compare)

575 Hill Country Dr
Suite 101
Kerrville, TX 78028-6024
Phone (830) 258-7090

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Peterson Medical Associates CurrentSince Oct 21, 2024 Accepting new patients

Locations

575 Hill Country Dr
Ste 202
Kerrville, TX 78028
Phone (830) 258-6237

575 Hill Country Dr
Ste 101
Kerrville, TX 78028
Phone (830) 258-7090

535 Hill Country Dr
Ste 201
Kerrville, TX 78028
Phone (830) 258-6249

Interoperability endpoints

  • Direct secure messaging: bryan.ishmael.1@21041.direct.athenahealth.com

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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": "1719446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1730924085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 HILL COUNTRY DR STE 101",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780286024",
            "telephone_number": "830-258-7090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 HILL COUNTRY DR STE 101",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780286024",
            "telephone_number": "830-258-7090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISHMAEL",
        "first_name": "BRYAN",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "MSN, APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-27",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1167768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kerrville, TX

Sources for this page

Verify at the official NPI Registry.