Jeremy Brenner, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9107287 Issued in FL

Practice address

303 N Clyde Morris Blvd
Daytona Beach, FL 32114-2709

Phone

(386) 425-2285

NPI assigned

Jul 22, 2013

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

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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.

• Halifax Healthcare Systems Inc

  • Family Medicine Physician
  • Daytona Beach, FL
  • NPI 1245283530
  Medicare reassignment NPD

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

{
    "created_epoch": "1374451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374710400000",
    "number": "1992147771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 864074",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328864074",
            "telephone_number": "386-226-4590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 N CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142709",
            "telephone_number": "386-425-2285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNER",
        "first_name": "JEREMY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-22",
        "last_updated": "2013-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9107287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tamika Brailsford
• Meghan Brand, MSW, PHD, LCSW
• Vicki Marcelle Brandenburg, ARNP
• Doris Louise Brantley
• Durant Daryl Brantley, MA
• Brianne Caitlin Breslin, RN
• Lydarius Dequan Brewer
• Lee Arnold Bridgewater, PH.D.
• Amanda Kristin Briese
• Ajahlei Broadus

• Medical Physician Assistant in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2013; 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.