Individual provider Active NPI

Brandon Lee Coburn, PA-C

  • Physician Assistant
  • Morgantown, WV
National Provider Identifier
1932706744
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1 Medical Center Dr
Morgantown, WV 26506-1200
Phone
(855) 988-2273
NPI assigned
Oct 5, 2020
Last updated
Jun 3, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X WV Primary
Physician Assistant 363A00000X C5-0011853 DE
Physician Assistant 363A00000X C0008580 MD

Addresses

Primary practice location

1 Medical Center Dr
Morgantown, WV 26506-1200

Mailing address

107 Staunton Dr
Weston, WV 26452-5604
Phone (304) 269-2022

Other practice location 1

107 Staunton Dr
Weston, WV 26452-5604
Phone (304) 269-2022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, MD, DC3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20201111000590 WV Practitioner - Physician Assistant 6204246804 Reassigns benefits to 2 organizations
I20221018001776 MD Practitioner - Physician Assistant 6204246804 Reassigns benefits to 2 organizations
I20230913000407 DC Practitioner - Physician Assistant 6204246804 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Medical Ctr Dr
Morgantown, WV 26506-1200
Phone (304) 598-4865

1325 Locust Ave
Fairmont, WV 26554-1435
Phone (304) 366-9999

1343 Locust Ave
Fairmont, WV 26554-1435
Phone (304) 363-4698

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C5-0011853DEMDPhysician Assistant
C0008580MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
West Virginia University Medical Corporation CurrentSince May 30, 2024 Accepting new patients
Health and Education Building CurrentSince May 30, 2024 Accepting new patients
Genesis Eldercare Physician Services LLC CurrentSince Jul 31, 2023 Accepting new patients
United Hospital Center, Inc. CurrentSince Apr 18, 2022 Accepting new patients
Genesis Eldercare Physician Services LLC CurrentSince Jul 31, 2023 Accepting new patients

Locations

3330 Wilkens Ave
Baltimore, MD 21229
Phone (410) 525-1544

347 Ballenger Center Dr
Frederick, MD 21703
Phone (301) 633-5181

1801 Wentworth Rd
Parkville, MD 21234
Phone (410) 661-5717

310 Genesis Way
Ste 600
Severna Park, MD 21146
Phone (410) 544-4220

3227 Bel Pre Rd
Silver Spring, MD 20906
Phone (301) 871-2000

327 Medical Park Dr
Bridgeport, WV 26330
Phone (681) 342-1000

916 W Main St
Bridgeport, WV 26330
Phone (304) 842-1034

4 Northridge Dr
Ste 118
Buckhannon, WV 26201
Phone (304) 473-1440

2673 Davisson Run Rd
Ste 303
Clarksburg, WV 26301

4498 Potomac Highlands Trl
Green Bank, WV 24944
Phone (304) 456-5115

1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500

266 Skidmore Ln
Sutton, WV 26601
Phone (304) 765-0351

107 Staunton Dr
Weston, WV 26452
Phone (304) 269-2022

149 Staunton Dr
Weston, WV 26452
Phone (304) 269-2022

Organizations & group practices 7

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.

Hospital & facility affiliations 1

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": "1601856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1932706744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 STAUNTON DR",
            "city": "WESTON",
            "state": "WV",
            "postal_code": "264525604",
            "telephone_number": "304-269-2022",
            "fax_number": "304-269-2037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265061200",
            "telephone_number": "855-988-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "107 Staunton Dr",
            "address_purpose": "LOCATION",
            "city": "Weston",
            "state": "WV",
            "postal_code": "264525604",
            "country_code": "US",
            "telephone_number": "304-269-2022",
            "fax_number": "304-269-2037",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COBURN",
        "first_name": "BRANDON",
        "middle_name": "LEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-05",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0011853",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0008580",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morgantown, WV

Sources for this page

Verify at the official NPI Registry.