Brandon Eugene Fornwalt

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

009926 Issued in AZ

Practice address

18699 N 67TH Ave Ste 300
Glendale, AZ 85308-7149

Phone

(623) 566-4718

Fax

(523) 566-4820

NPI assigned

Feb 14, 2018

Last updated

Jul 3, 2023By the provider in NPPES

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 AZ

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

Specialty

Otolaryngology

Education

Arizona College of Osteopathic Medicine Mid Western University, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valley ENT PCGroup PAC ID 8729149711, 70 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Abrazo Arrowhead Hospital Hospital, Glendale, AZ, CCN 030094

Merit-based Incentive Payment System (MIPS)

Final score

83.58 of 100Reported as group

Quality

71.49

Promoting interoperability

100

Improvement activities

40

Cost

73.79

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

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.

• Valley ENT, PC

  • Otolaryngology Physician
  • Scottsdale, AZ
  • NPI 1508990185
  Medicare reassignment Care Compare group
• Northern Arizona Ear Nose and Throat PC

  • Otolaryngology Physician
  • Flagstaff, AZ
  • NPI 1558449900
  NPD (past)
• Valley ENT, PC

  • Otolaryngology Physician
  • Tucson, AZ
  • NPI 1770852600
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• VHS of Arrowhead, Inc

  dba Abrazo Arrowhead Campus

  • General Acute Care Hospital
  • Glendale, AZ
  • NPI 1326022765
  Care Compare affiliation
• VHS of Arrowhead, Inc.

  dba Abrazo Peoria Emergency Center

  • General Acute Care Hospital
  • Peoria, AZ
  • NPI 1801340781
  Care Compare affiliation

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

{
    "created_epoch": "1518566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688342400000",
    "number": "1912407172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9097 E DESERT COVE AVE STE 200",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852606280",
            "telephone_number": "928-614-7516",
            "fax_number": "480-214-9929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18699 N 67TH AVE STE 300",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853087149",
            "telephone_number": "623-566-4718",
            "fax_number": "523-566-4820"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9250 W Thomas Rd Ste 350",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850373385",
            "country_code": "US",
            "telephone_number": "623-848-8890",
            "fax_number": "623-848-7848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORNWALT",
        "first_name": "BRANDON",
        "middle_name": "EUGENE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-14",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "AZ",
            "license": "009926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Blair Forester, FNP
• Forever Farm Inc
• Forever Safe Home Care, Inc.
• Forever There Home Care LLC
• Eva Beatrix Forney
• Christina Forrey
• Adrienne W Forstner-Barthell, MD
• Cliff R Fortunat, PTA
• Forward Care Family Practice, PLLC
• Jonathan D Fosbre, NP-C

• Otolaryngology Physician in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Otolaryngology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.