Individual provider Active NPI

Brenda Hage, CRNP

  • Nurse Practitioner
  • Wilkes Barre, PA
National Provider Identifier
1992790992
Registry record updated Jun 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
TP-003758-B Issued in PA
Practice address
150 Mundy St
Wilkes Barre, PA 18702-6830
Phone
(570) 824-0930
Fax
(570) 824-7755
NPI assigned
Sep 15, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X TP-003758-B PA Primary

Addresses

Primary practice location

150 Mundy St
Wilkes Barre, PA 18702-6830

Mailing address

150 Mundy St
Wilkes Barre, PA 18702-6830
Phone (570) 824-0930

Other identifiers 3

IdentifierTypeStateIssuer
P00155573OtherPARAILROAD MEDICARE
892898OtherPABLUE CARE
50076561OtherPACAPITAL 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)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
TP-003758-BPAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Rehabilitation Associates, PC PastSince Feb 13, 2023 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.

NPI Registry JSON

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245283200000",
    "number": "1992790992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MUNDY ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187026830",
            "telephone_number": "570-824-0930",
            "fax_number": "570-824-7755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MUNDY ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187026830",
            "telephone_number": "570-824-0930",
            "fax_number": "570-824-7755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGE",
        "first_name": "BRENDA",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-15",
        "last_updated": "2009-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "TP-003758-B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00155573",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE",
            "identifier": "892898",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "50076561",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2009; 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.