Domenick Braccia, DO

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

0S006737L Issued in PA

Practice address

1035 Virginia Dr
Fort Washington, PA 19034-3103

Phone

(267) 419-7710

NPI assigned

Oct 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 1, 2015 through Jul 1, 2027

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1821178005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 VIRGINIA DR",
            "city": "FORT WASHINGTON",
            "state": "PA",
            "postal_code": "19034",
            "telephone_number": "267-419-7710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 VIRGINIA DR",
            "city": "FORT WASHINGTON",
            "state": "PA",
            "postal_code": "190343103",
            "telephone_number": "267-419-7710"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "345 Main St",
            "address_2": "Suite 4",
            "address_purpose": "LOCATION",
            "city": "Harleysville",
            "state": "PA",
            "postal_code": "194382428",
            "country_code": "US",
            "telephone_number": "215-256-0050",
            "fax_number": "215-256-0059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRACCIA",
        "first_name": "DOMENICK",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "0S006737L",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "PA",
            "license": "0S006737L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012371310008",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beth A. Bond, ATC
• Cory Borisoff
• Stephanie Bosque
• Whitney Bowles, FNP
• Michele Victoria Bowne, LCSW
• Lauren Brady, M.S.
• Shahdae Brady
• John W Breckenridge, M.D.
• Brimmark Health Group
• Alexis L. Britford, LPC, R-DMT

• Addiction Medicine (Family Medicine) Physician in Fort Washington, PA
• Providers in Fort Washington, PA by specialty
• Addiction Medicine (Family Medicine) Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.