Brett Gerald Bagley, P.A. - CERTIFIED

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA-215 Issued in ID

Practice address

556 Trejo St
Suite B
Rexburg, ID 83440

Phone

(208) 359-2263

Fax

(208) 359-2042

NPI assigned

Jan 25, 2007

Last updated

Jun 26, 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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ID

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

Specialty

Physician Assistant

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Fall Creek Skin and Health PLLC

  • Medical Physician Assistant
  • Rexburg, ID
  • NPI 1629247093
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1932254133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "534 TREJO ST STE 400",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834405405",
            "telephone_number": "208-359-2263",
            "fax_number": "208-359-2042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "556 TREJO ST",
            "address_2": "SUITE B",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "83440",
            "telephone_number": "208-359-2263",
            "fax_number": "208-359-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGLEY",
        "first_name": "BRETT",
        "middle_name": "GERALD",
        "name_prefix": "Mr.",
        "credential": "P.A. - CERTIFIED",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805069800",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION",
            "identifier": "201139500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fay Coleman Ashment, APPN-NP
• Dee W Atkinson, PHARM.D.
• Jonathan Arthur Austad
• Back to Health Chiropractic Clinic Inc
• Back to Health Chiropractic LLC
• Kendra Lyn Bagshaw, LCPC
• Jorie Bailey
• Ashleigh Ball, PTA
• Brittney Ball
• Brianne R Banks, SLP

• Medical Physician Assistant in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Medical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.
• 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.