Individual provider Active NPI

Branden Deyerle, M.D.

  • Obstetrics & Gynecology Physician
  • Newport News, VA
National Provider Identifier
1861854689
Registry record updated Jun 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
0101269747 Issued in VA
Practice address
12706 McManus Blvd
Newport News, VA 23602-4460
Phone
(757) 874-2229
NPI assigned
Mar 22, 2016
Last updated
Jun 29, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 0101269747 VA Primary

Addresses

Primary practice location

12706 McManus Blvd
Newport News, VA 23602-4460

Mailing address

12706 McManus Blvd
Newport News, VA 23602-4460
Phone (757) 874-2229

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200805002088 VA Practitioner - Obstetrics/Gynecology 8527483734 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Eastern Virginia Medical School, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12706 McManus Blvd
Newport News, VA 23602-4460

53 7TH Ave
Hudson Falls, NY 12839-1044

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101269747VAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Atlantic Womens Care PLC Obstetrics & Gynecology CurrentSince Aug 31, 2020 Accepting new patients
Obhg Virginia, LLC Obstetrics & Gynecology CurrentSince Nov 4, 2023 Accepting new patients
Mid-Atlantic Womens Care PLC Obstetrics & Gynecology Past Accepting new patients
Mid-Atlantic Womens Care PLC Obstetrics & Gynecology Past Accepting new patients
Mid-Atlantic Womens Care PLC Obstetrics & Gynecology PastSince Jun 28, 2020 Accepting new patients

Locations

13710 St Francis Blvd
Midlothian, VA 23114
Phone (804) 594-7300

12706 McManus Blvd
Newport News, VA 23602
Phone (757) 874-2229

704 Thimble Shoals Blvd
Ste 500B
Newport News, VA 23606
Phone (757) 599-3436

844 Kempsville Rd
Ste 208
Norfolk, VA 23502
Phone (757) 461-3890

200 Medical Park Blvd
Petersburg, VA 23805
Phone (804) 765-5000

Interoperability endpoints

  • Direct secure messaging: branden.deyerle.1@22824.direct.athenahealth.com

Organizations & group practices 5

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.

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": "1458604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593388800000",
    "number": "1861854689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12706 MCMANUS BLVD",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236024460",
            "telephone_number": "757-874-2229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12706 MCMANUS BLVD",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236024460",
            "telephone_number": "757-874-2229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEYERLE",
        "first_name": "BRANDEN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-22",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "VA",
            "license": "0101269747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport News, VA

Sources for this page

Verify at the official NPI Registry.