Brandon Jay Blank, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-04304 Issued in NC

Practice address

3333 Silas Creek Pkwy
Emergency Department
Winston Salem, NC 27103-3013

Phone

(336) 765-9328

Fax

(336) 768-5762

NPI assigned

Jun 25, 2013

Sex

Male

Sole proprietor

No

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 NC

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, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Charlotte Eye Ear Nose and Throat Associates PAGroup PAC ID 0446155451, shared by 3 NPIs, 181 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: brandonblank@penta.allscriptsdirect.net

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.

• Forsyth Emergency Services, P.a.

  • Emergency Medicine Physician
  • Winston-Salem, NC
  • NPI 1649256983

  NC

  Medicare reassignment

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

• Forsyth Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1447200233

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1372118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603929600000",
    "number": "1770923682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 25477",
            "address_2": "FORSYTH EMERGENCY SERVICES P.A.",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271145447",
            "telephone_number": "336-765-9328",
            "fax_number": "336-768-5762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 SILAS CREEK PKWY",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033013",
            "telephone_number": "336-765-9328",
            "fax_number": "336-768-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANK",
        "first_name": "BRANDON",
        "middle_name": "JAY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-25",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-04304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philip David Blalock I, SPEECH PATHOLOGIST
• Rueben Benjamin Blancas, CRNA
• Kristi Blanco
• Kristine Kapicak Blanco, P.T.
• Deirdre R Bland, MD
• Hannah Blank
• Janet Louise Blank, M.A.
• Elizabeth Boles Blankenship, PA
• Heath Tayton Blankenship, MD
• Sarah Anne Blankenship, FNP-C

• All providers in Winston Salem, NC
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; 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.