Individual provider Active NPI

Dennis Michael Brennan, PA-C

  • Medical Physician Assistant
  • Rising Star, TX
National Provider Identifier
1962577866
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA03746 Issued in TX
Practice address
1870A Highway 36 W
Rising Star, TX 76471-3454
Phone
(254) 643-3235
Fax
(254) 643-3233
NPI assigned
Nov 24, 2006
Last updated
Sep 21, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA03746 TX Primary

Addresses

Primary practice location

1870A Highway 36 W
Rising Star, TX 76471-3454

Mailing address

1870A Highway 36 W
Rising Star, TX 76471-3454
Phone (254) 643-3235

Other identifiers 1

IdentifierTypeStateIssuer
PA03746OtherTXLICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20100114000399 TX Practitioner - Physician Assistant 5395886279 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Comanche County Medical Center CompanyGroup PAC ID 3678753357, shared by 2 NPIs, 23 clinicians
Tanana Chiefs ConferenceGroup PAC ID 9537050109, 148 clinicians

Practice addresses (Care Compare)

10201 Hwy 16
Comanche, TX 76442-4462
Phone (254) 879-4900

1717 W Cowles St
Fairbanks, AK 99701-5926
Phone (907) 451-6682

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA03746TXMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Regional Employee Assistance Program Inc CurrentSince Apr 1, 2011 Accepting new patients
Regional Employee Assistance Program Inc CurrentSince Apr 1, 2011 Accepting new patients
Tanana Chiefs Conference CurrentSince Jul 19, 2019 Accepting new patients
Regional Employee Assistance Program Inc Past Accepting new patients

Locations

1717 W Cowles St
Fairbanks, AK 99701
Phone (907) 452-6682

2005 Highway 183 N
Early, TX 76802
Phone (325) 643-3010

Interoperability endpoints

  • Direct secure messaging: dennis.brennan.1@15989.direct.athenahealth.com

Organizations & group practices 5

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 3

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": "1164326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1962577866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1870A HIGHWAY 36 W",
            "city": "RISING STAR",
            "state": "TX",
            "postal_code": "764713454",
            "telephone_number": "254-643-3235",
            "fax_number": "325-643-3233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1870A HIGHWAY 36 W",
            "city": "RISING STAR",
            "state": "TX",
            "postal_code": "764713454",
            "telephone_number": "254-643-3235",
            "fax_number": "254-643-3233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNAN",
        "first_name": "DENNIS",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-24",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA03746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "PA03746",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rising Star, TX

Sources for this page

Verify at the official NPI Registry.