John S Braxton III, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

C0000645 Issued in MD

Practice address

253 Lewis LN
Suite 202
Havre de Grace, MD 21078-3750

Phone

(443) 502-7060

Fax

(410) 378-9922

NPI assigned

May 24, 2005

Sex

Male

Sole proprietor

No

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 MD

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

Credentials

Physician Assistant

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/7962/brand/1/csg/1/fhir/r4
• FHIR API: https://api.platform.athenahealth.com/13477/brand/1/csg/1/fhir/r4

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.

• MD Immediate Care LLC

  • Urgent Care Clinic/Center
  • Havre de Grace, MD
  • NPI 1770824195
  Medicare reassignment

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450137600000",
    "number": "1902809734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99",
            "city": "CONOWINGO",
            "state": "MD",
            "postal_code": "219180099",
            "telephone_number": "410-378-9696",
            "fax_number": "410-378-9922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "253 LEWIS LN",
            "address_2": "SUITE 202",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783750",
            "telephone_number": "443-502-7060",
            "fax_number": "410-378-9922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAXTON",
        "first_name": "JOHN",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2015-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0000645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Toni Allayne Boulware Stackhouse
• Tonya Anitra Bowens, PMHNP-BC
• Sakeena Jentae Bowman, COTA/L
• Debbie L Boyd, CRNP
• Kelly Bragg, LCPC
• Brenda Jaffe, LCSW-C, LLC
• Brian C. de Muth M.D., PA
• Brian C. de Muth, M.D., PA
• Jessica Tierra Bridges
• Bright Minds Therapy, LLC

• Physician Assistant in Havre de Grace, MD
• Providers in Havre de Grace, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2015; 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.