Individual provider Active NPI

Brandon Lee Carle

  • Physician Assistant
  • Bettendorf, IA
National Provider Identifier
1952076523
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
118760 Issued in IA
Practice address
912 Middle Rd
Bettendorf, IA 52722-4104
Phone
(563) 554-9676
NPI assigned
Aug 14, 2021
Last updated
Mar 9, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 118760 IA Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

912 Middle Rd
Bettendorf, IA 52722-4104

Mailing address

2629 Letaville Dr
Muscatine, IA 52761-8611
Phone (563) 554-9676

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
118760IAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
LMMC Lincoln, LLC Past Accepting new patients
LMMC Des Moines LLLP Past Accepting new patients
LMMC Council Bluffs LLLP Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1628899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1952076523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2629 LETAVILLE DR",
            "city": "MUSCATINE",
            "state": "IA",
            "postal_code": "527618611",
            "telephone_number": "563-554-9676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 MIDDLE RD",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527224104",
            "telephone_number": "563-554-9676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLE",
        "first_name": "BRANDON",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-14",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "118760",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bettendorf, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.