NPIMap

Individual provider Active NPI

Brandon Allan Wilson, PA-C

  • Physician Assistant
  • Baltimore, MD
National Provider Identifier
1902381353
Registry record updated Jul 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C06974 Issued in MD
Practice address
2700 Quarry Lake Dr Ste 300
Baltimore, MD 21209-3746
Phone
(410) 377-8900
NPI assigned
Oct 2, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X CN06974 MD
Physician Assistant 363A00000X C06974 MD Primary

Addresses

Primary practice location

2700 Quarry Lake Dr Ste 300
Baltimore, MD 21209-3746

Mailing address

2700 Quarry Lake Dr Ste 300
Baltimore, MD 21209-3746
Phone (410) 377-8900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181226001298 MD Practitioner - Physician Assistant 7719222512 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
May accept Medicare assignment
Group practices
Sinai Hospital of Baltimore, IncGroup PAC ID 0941112346, 373 clinicians

Practice addresses (Care Compare)

2401 E Belvedere Ave
Baltimore, MD 21215-5216

2411 W Belvedere Ave
Baltimore, MD 21215-5217

2411 W Belvedere Ave 5TH Floor
Sinai Ophthalmology Associates
Baltimore, MD 21215-5217
Phone (410) 601-5700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C06974MDMDPhysician Assistant
CN06974MDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Centers for Advanced Orthopaedics, LLC CurrentSince Jul 25, 2022 Accepting new patients
Sinai Hospital of Baltimore, Inc. CurrentSince Aug 1, 2019 Accepting new patients
Sinai Hospital of Baltimore Inc CurrentSince Aug 1, 2019 Accepting new patients
Centers for Advanced Orthopaedics, LLC CurrentSince Jul 25, 2022 Accepting new patients
Sinai Hospital of Baltimore Inc Past Accepting new patients
Centers for Advanced Orthopaedics, LLC Past Accepting new patients
Orthopaedic Associates of Central Maryland, PA Past Accepting new patients

Locations

2401 W Belvedere Ave
Baltimore, MD 21215

2435 W Belvedere Ave
Ste 51
Baltimore, MD 21215
Phone (410) 578-5392

2700 Quarry Lake Dr
Ste 300
Baltimore, MD 21209

2411 W Belvedere Ave
Baltimore, MD 21215
Phone (410) 601-5700

10710 Charter Dr
Ste 300
Columbia, MD 21044
Phone 4106441880450

1312 Bellona Ave
Ste 302
Lutherville Timonium, MD 21093
Phone (301) 637-8712

4 Park Center Ct
Ste 102
Owings Mills, MD 21117
Phone (410) 377-3484

Interoperability endpoints

  • Direct secure messaging: 38bwilson@cfaortho.emadirect.md

Organizations & group practices 9

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.

Hospital & facility affiliations 2

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": "1538438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1902381353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 QUARRY LAKE DR STE 300",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093746",
            "telephone_number": "410-377-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 QUARRY LAKE DR STE 300",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093746",
            "telephone_number": "410-377-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "BRANDON",
        "middle_name": "ALLAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-02",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "CN06974",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C06974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.