Individual provider Active NPI

Erin Nichole Brantley, PA

  • Physician Assistant
  • Lawrenceville, GA
National Provider Identifier
1851827430
Registry record updated Nov 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
758 Old Norcross Rd Ste 100
Lawrenceville, GA 30046-3386
Phone
(770) 962-4300
Fax
(770) 339-7544
NPI assigned
May 3, 2017
Last updated
Nov 6, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2018

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 GA Primary

Addresses

Primary practice location

758 Old Norcross Rd Ste 100
Lawrenceville, GA 30046-3386

Mailing address

64 Omega Dr
Lawrenceville, GA 30044-4221
Phone (678) 206-7155

Other names 1

  • Ms. Erin Nichole Mingledorff Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20171011000169 GA Practitioner - Physician Assistant 1254606601 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Resurgens, LLCGroup PAC ID 1153224142, 184 clinicians
Esop Rehabilitation LLCGroup PAC ID 9739305749, shared by 9 NPIs, 224 clinicians

Practice addresses (Care Compare)

1223 Friendship Rd
Suite 220
Braselton, GA 30517-5608
Phone (470) 762-3641

1699 Hwy 124 N
Suite 100
Snellville, GA 30078-7921
Phone (678) 218-6702

5671 Peachtree Dunwoody Rd
Suite 900
Atlanta, GA 30342-5022

5671 Peachtree Dunwoody Rd NE
Suite 900 950
Atlanta, GA 30342-5022
Phone (404) 847-9999

758 Old Norcross Rd
Suite 175
Lawrenceville, GA 30046-3386
Phone (678) 985-7190

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
008411GAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Resurgens, LLC CurrentSince Jul 13, 2017 Accepting new patients
Resurgens, LLC CurrentSince Jul 13, 2017 Accepting new patients
Resurgens, LLC PastSince Mar 1, 2022 Accepting new patients

Locations

1223 Friendship Rd
Ste 220
Braselton, GA 30517
Phone (470) 762-3641

758 Old Norcross Rd
Ste 100
Lawrenceville, GA 30046
Phone (770) 962-4300

5671 Ptree Dunwoody Rd NE
Ste 900
Sandy Springs, GA 30342
Phone (404) 531-8590

Interoperability endpoints

  • Direct secure messaging: erin.mingledorff.1@15749.direct.athenahealth.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1493769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541462400000",
    "number": "1851827430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 OMEGA DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300444221",
            "telephone_number": "678-206-7155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "758 OLD NORCROSS RD STE 100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463386",
            "telephone_number": "770-962-4300",
            "fax_number": "770-339-7544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANTLEY",
        "first_name": "ERIN",
        "middle_name": "NICHOLE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-03",
        "last_updated": "2018-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERIN",
            "last_name": "MINGLEDORFF",
            "middle_name": "NICHOLE",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.