Rebekah June Braunlich, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

030802 Issued in NY

Practice address

510 S 4TH St
Fulton, NY 13069-2951

Phone

(315) 592-3510

NPI assigned

Jul 2, 2022

Last updated

Nov 25, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Rebekah June Braunlich Other name

Medicare fee-for-service enrollment

Enrolled in NY

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Port City Emergency Physicians LLPGroup PAC ID 0345301917, 46 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Port City Emergency Physicians LLP

  • Emergency Medicine Physician
  • Oswego, NY
  • NPI 1134370547
  Medicare reassignment Care Compare group
• Port City Emergency Physicians LLP

  • Emergency Medicine Physician
  • Hamilton, NY
  • NPI 1316395460

  Physician Assistant

  NPD

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

{
    "created_epoch": "1656720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1780317263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 S 4TH ST",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130692951",
            "telephone_number": "315-592-3510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 S 4TH ST",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130692951",
            "telephone_number": "315-592-3510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAUNLICH",
        "first_name": "REBEKAH",
        "middle_name": "JUNE",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-02",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "030802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REBEKAH",
            "last_name": "BRAUNLICH",
            "middle_name": "JUNE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Michael J. Botty, D.D.S.
• Paula M Bourgeois, LPN
• Deneen D Bowman, FNP
• Gary Douglas Bozeman, M.D.
• Michael Joseph Branish, RPH
• Shannon E Brazill, M.S. CCC-SLP
• Danielle Breman, LMSW
• Kasey Brenon, LMHC
• Cassandra Brown, RN,LENS PRACTITIONER
• Anthony Bryant, PMHNP

• Physician Assistant in Fulton, NY
• Providers in Fulton, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.