Active NPI
Wayne E Branson, RNFA
- Registered Nurse First Assistant
- Rockford, IL
National Provider Identifier
1972749158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse First Assistant
- License
- 041224814
- Practice address
- 1401 E State St
Rockford, IL 61104-2315 - Phone
- (815) 489-4400
- NPI assigned
- Dec 18, 2008
- Last updated
- Dec 18, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse First Assistant | 163WR0006X | 041224814 | IL | Primary |
Addresses
Primary practice location
1401 E State St
Rockford, IL 61104-2315
Mailing address
PO Box 1567
Rockford, IL 61110-0067
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010122910 | Other | IL | BLUE CROSS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041224814 | IL | MD | Registered Nurse First Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Swedishamerican Hospital | Past | Accepting new patients | |
| Swedishamerican Hospital | Past | Accepting new patients |
Organizations & group practices 2
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229558400000",
"number": "1972749158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1567",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611100067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 E STATE ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611042315",
"telephone_number": "815-489-4400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANSON",
"first_name": "WAYNE",
"middle_name": "E",
"credential": "RNFA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-12-18",
"last_updated": "2008-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "163WR0006X",
"taxonomy_group": "",
"desc": "Registered Nurse, Registered Nurse First Assistant",
"state": "IL",
"license": "041224814",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "010122910",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.