Braton Fredline, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601012396 Issued in MI

Practice address

300 68TH St SE
Grand Rapids, MI 49548-6927

Phone

(616) 455-5000

NPI assigned

Jul 29, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR, MI2 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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pine Rest Christian Mental Health ServicesGroup PAC ID 4981506508, 354 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bfredline79759@direct.slhs.org

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.

• Pine Rest Christian Mental Health Services

  • General Practice Physician
  • Grand Rapids, MI
  • NPI 1851309884
  Medicare reassignment Care Compare group NPD
• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058

  OR

  Medicare reassignment NPD
• Pine Rest Christian Mental Health Services

  • Professional Counselor
  • Grand Rapids, MI
  • NPI 1386015683
  NPD
• St Lukes Clinic-Treasure Valley LLC

  • Rural Health Clinic/Center
  • Baker City, OR
  • NPI 1336442607

  Family Medicine

  NPD
• St Luke'S Magic Valley Regional Medical Center LTD

  • Community/Retail Pharmacy
  • Twin Falls, ID
  • NPI 1760203921
  NPD (past)

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

{
    "created_epoch": "1469750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1740733401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3950 17th St Ste A",
            "address_purpose": "LOCATION",
            "city": "Baker City",
            "state": "OR",
            "postal_code": "978141300",
            "country_code": "US",
            "telephone_number": "541-523-1001",
            "fax_number": "541-523-1152",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FREDLINE",
        "first_name": "BRATON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-29",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA190887",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "PineRestCMHS@directaddress.pinerest.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "300 68th St SE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495486927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ryan Frederick
• Yuvonne Frederick
• Hunter Curtis Frederickson
• Emily Lauren Fredette
• Alyssa Grace Fredin
• Hilary May Fredricks, DPT
• Sarah Marie Fredricks, PHARMD
• Mark A Fredrickson, MD
• Mary Vogel Fredrickson, PA-C
• Lara A Freeburger, MD

• Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; 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.