Justin Patrick Bryan, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA6265 Issued in MA

Practice address

125 Parker Hill Ave BLDG Suite560
Boston, MA 02120-2847

Phone

(617) 860-6130

Fax

(617) 860-6135

NPI assigned

Jul 11, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1531267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531267200000",
    "number": "1982180196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 ATKINS ST APT 2",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021351602",
            "telephone_number": "207-233-5289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 PARKER HILL AVE BLDG SUITE560",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021202847",
            "telephone_number": "617-860-6130",
            "fax_number": "617-860-6135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "JUSTIN",
        "middle_name": "PATRICK",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-11",
        "last_updated": "2018-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA6265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roland R Brusseau, MD
• Robert M Brustowicz, MD
• Lynn Bry, MD
• Allen Wayne Bryan Jr., M.D., PH.D.
• Elisabeth Lawrence Bryan, LICSW
• Lia Michele Bryan
• Oceana Bryan
• Allison S. Bryant Mantha, M.D., M.P.H.
• Jessica Bryant
• Kaitlin Bryant, LICSW

• Physician Assistant in Boston, MA
• Providers in Boston, MA by specialty
• Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.