Individual provider Active NPI

Amy Grace Brandeburg

  • Physician Assistant
  • Memphis, TN
National Provider Identifier
1760295075
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
6019 Walnut Grove Rd
Memphis, TN 38120-2113
Phone
(901) 226-5000
NPI assigned
Jan 30, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X TN Primary

Addresses

Primary practice location

6019 Walnut Grove Rd
Memphis, TN 38120-2113

Mailing address

265 Brookview Centre Way Ste 400
Knoxville, TN 37919-4052
Phone (800) 342-2898

Other practice location 1

5150 Airline Rd
Arlington, TN 38002-8008
Phone (901) 226-1850

Other practice location 2

1500 W Poplar Ave
Collierville, TN 38017-0601
Phone (901) 861-9000

Other names 1

  • Amy Grace Fister Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20251112003113 TN Practitioner - Physician Assistant 6103317698 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Emergency Physicians LLCGroup PAC ID 2466364997, 776 clinicians

Practice addresses (Care Compare)

5150 Airline Rd
Arlington, TN 38002-8008
Phone (865) 985-7047

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
6684TNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Emergency Physicians LLC Physician Assistant CurrentSince Oct 22, 2025 Accepting new patients

Locations

5150 Airline Rd
Arlington, TN 38002
Phone (865) 985-7047

1500 W Poplar Ave
Collierville, TN 38017
Phone (901) 227-8140

9352 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-1000

6019 Walnut Grove Rd
Memphis, TN 38120
Phone (901) 226-3190

Interoperability endpoints

  • Direct secure messaging: abrandeburg600307@direct.bmhcc.org

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 1

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": "1738195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1760295075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "265 BROOKVIEW CENTRE WAY STE 400",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379194052",
            "telephone_number": "800-342-2898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6019 WALNUT GROVE RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202113",
            "telephone_number": "901-226-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5150 Airline Rd",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TN",
            "postal_code": "380028008",
            "country_code": "US",
            "telephone_number": "901-226-1850",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 W Poplar Ave",
            "address_purpose": "LOCATION",
            "city": "Collierville",
            "state": "TN",
            "postal_code": "380170601",
            "country_code": "US",
            "telephone_number": "901-861-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRANDEBURG",
        "first_name": "AMY",
        "middle_name": "GRACE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-30",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "FISTER",
            "middle_name": "GRACE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.