NPIMap

Individual provider Active NPI

Michael Dale Brackenrich, D.O.

  • Family Medicine Physician
  • Rich Creek, VA
National Provider Identifier
1972603744
Registry record updated Jan 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0102036943 Issued in VA
Practice address
363 Woodland St
Rich Creek, VA 24147-0336
Phone
(540) 726-2375
NPI assigned
Sep 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0102036943 VA Primary

Addresses

Primary practice location

363 Woodland St
Rich Creek, VA 24147-0336

Mailing address

363 Woodland St
PO Box B
Rich Creek, VA 24147
Phone (540) 726-2375

Other identifiers 1

IdentifierTypeStateIssuer
005696208MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090413000288 VA Practitioner - Family Practice 7911054853 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brackenrich Family Practice PLCGroup PAC ID 9739236670, 2 clinicians

Practice addresses (Care Compare)

363 Woodland St
Rich Creek, VA 24147
Phone (540) 726-2375

Hospital & facility affiliations

  • Amedisys Home Health Care Home health agency, Roanoke, VA, CCN 497275
  • Adoration Home Health Home health agency, Charleston, WV, CCN 517115
  • Princeton Community Hospital Assn Inc Hospital, Princeton, WV, CCN 510046
  • Carilion Giles Community Hospital Hospital, Pearisburg, VA, CCN 491302
  • Lewisgale Hospital Montgomery Hospital, Blacksburg, VA, CCN 490110
  • Heritage Hall-Rich Creek Nursing home, Rich Creek, VA, CCN 495371

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1148WVMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Brackenrich Family Practice, PLC Family Medicine CurrentSince Mar 3, 2009 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

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": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296172800000",
    "number": "1972603744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "363 WOODLAND ST",
            "address_2": "PO BOX B",
            "city": "RICH CREEK",
            "state": "VA",
            "postal_code": "24147",
            "telephone_number": "540-726-2375",
            "fax_number": "540-726-3573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 WOODLAND ST",
            "city": "RICH CREEK",
            "state": "VA",
            "postal_code": "241470336",
            "telephone_number": "540-726-2375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACKENRICH",
        "first_name": "MICHAEL",
        "middle_name": "DALE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2011-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0102036943",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005696208",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rich Creek, VA

Sources for this page

Verify at the official NPI Registry.