Michael Philip Bronnenberg, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PENDING Issued in NH

Practice address

250 Pleasant St
Concord, NH 03301-7539

Phone

(603) 227-7000

NPI assigned

Jan 8, 2018

Last updated

Jan 8, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 NH

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

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Concord Imaging Center

  • Radiology Clinic/Center
  • Concord, NH
  • NPI 1700859451
  Medicare reassignment
• X-Ray Professional Association

  • Diagnostic Radiology Physician
  • Concord, NH
  • NPI 1790758449
  Medicare reassignment

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

{
    "created_epoch": "1515369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515369600000",
    "number": "1881101178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 MAIN ST",
            "city": "CHICHESTER",
            "state": "NH",
            "postal_code": "032586509",
            "telephone_number": "603-897-9128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 PLEASANT ST",
            "city": "CONCORD",
            "state": "NH",
            "postal_code": "033017539",
            "telephone_number": "603-227-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONNENBERG",
        "first_name": "MICHAEL",
        "middle_name": "PHILIP",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-08",
        "last_updated": "2018-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NH",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bright Light Community Services
• Bright River Counseling LLC
• Sandra L Bristol, ARNP
• Elizabeth Broadbent
• Constantine P Brocoum, MD
• Megan Brookman, MA
• Trisha Brooks, APRN
• Kelly Brough, MS
• Holly Brouillet
• Wendy Brown-Perry, CPNP

• Medical Physician Assistant in Concord, NH
• Providers in Concord, NH by specialty
• Medical Physician Assistant in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.