Edward John Brandecker, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

J2508 Issued in TX

Practice address

1888 Antilley Rd
Abilene, TX 79606-5205

Phone

(325) 795-9550

Fax

(325) 795-9537

NPI assigned

Jun 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: ebrandec@yourcarecommunity.org

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.

• Privia Medical Group West Texas, PLLC

  • Pathology Specialist/Technologist
  • Abilene, TX
  • NPI 1760482665
  NPD (past)

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348531200000",
    "number": "1992700413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1888 ANTILLEY RD",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796065205",
            "telephone_number": "325-795-9550",
            "fax_number": "325-795-9537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1888 ANTILLEY RD",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796065205",
            "telephone_number": "325-795-9550",
            "fax_number": "325-795-9537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDECKER",
        "first_name": "EDWARD",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2012-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "TX",
            "license": "J2508",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "J2508",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4223641",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS/ADC",
            "identifier": "8X7151",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102408501",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTCARE/ADC",
            "identifier": "109067104",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "81T422",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID/ADC",
            "identifier": "102408503",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTCARE",
            "identifier": "109067100",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCR RXR",
            "identifier": "CR1046",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "250003414",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donald M Bradshaw, MD
• Bethany Joy Brady, RD
• Branon Chad Brady
• Brain and Heart Healing, PLLC
• Misty Michelle Braly, MPT
• Nicholas Wade Brandstetter, PHARM.D
• Sarah Monica Branstutter-Peckham
• Emily Braun
• Lawrence Richard Breitkreutz Jr., M.D.
• Jennifer Marie Brenem, OTR

• Physical Medicine & Rehabilitation Physician in Abilene, TX
• Providers in Abilene, TX by specialty
• Physical Medicine & Rehabilitation Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.