BRENT CHARLES DEATHERAGE PA-C
NPI 1336373257
Physician Assistant - Medical in Charlotte, NC

Q: What is Brent Deatherage's NPI number?

The NPI number for Brent Deatherage is 1336373257. It was assigned to this individual provider in the NPPES registry on May 6, 2009.

Q: What is Brent Deatherage's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Brent Deatherage was last updated on August 10, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 06, 2009PECOS EnrolledAccepts Medicare Assignment

1900 RANDOLPH RD, SUITE 900, CHARLOTTE, NC 28207(704) 377-2424(704) 377-2687 Get Directions Write a Review

NPPES record last updated: August 10, 2012. Verified against the NPPES registry weekly; last sync: October 04, 2026.

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About Brent Charles Deatherage Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRENT CHARLES DEATHERAGE PA-C (NPI 1336373257) is an individual medical provider in Charlotte, North Carolina, licensed in North Carolina (0010-03428) and active in the NPI registry since May 2009. He is enrolled in Medicare PECOS and is a graduate of Other (2008).

NPPES Registry Identity

NPI1336373257

Entity TypeIndividualMale

Primary Taxonomy363AM0700X

Provider Legal NameBRENT CHARLES DEATHERAGECredential: PA-C

Location Address1900 RANDOLPH RD, SUITE 900Charlotte, NC 28207-1122

Mailing Address1900 Randolph Rd, Suite 900Charlotte, NC 28207-1122 · (704) 377-2424 · Fax (704) 377-2687

Phone(704) 377-2424

Fax(704) 377-2687

Sole ProprietorNo

Medical School CMSOtherGraduated 2008

Enumeration DateMay 6, 2009

Last NPPES UpdateAugust 10, 2012

✔ NPI 1336373257 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in NC · 0010-03428

Also ListedPhysician Assistant · SurgicalTaxonomy 363AS0400X · License PA9104956 (FL)

1900 RANDOLPH RD, Charlotte, NC 28207

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Brent Charles Deatherage Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID547312308

PECOS Enrollment IDI20190627001749

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NOVANT HEALTH MEDICAL GROUP, LLC

Internal Medicine (Infectious Disease)

1900 RANDOLPH RD, SUITE 216
CHARLOTTE, NC 28207

Mecklenburg County (704) 384-5416

JOHN B CLARK JR. M.D.

Emergency Medicine

1900 RANDOLPH RD, STE 900
CHARLOTTE, NC 28207

Mecklenburg County (704) 377-2424

DR. SHANA DALE WALLACE MD

Psychiatry & Neurology (Neurology with Special Qualifications in Child Neurology)

1900 RANDOLPH RD, SUITE 1010
CHARLOTTE, NC 28207

Mecklenburg County (704) 384-1390

SACHIN JAMNADAS HANSALIA M.D.

Internal Medicine (Critical Care Medicine)

1900 RANDOLPH RD, SUITE 580
CHARLOTTE, NC 28207

Mecklenburg County (704) 384-9900

JAMES E PUGH MD

Psychiatry & Neurology (Neurology)

1900 RANDOLPH RD, SUITE 1010
CHARLOTTE, NC 28207

Mecklenburg County (704) 334-7311

DONALD P. RUSH LCSW

Social Worker (Clinical)

1900 RANDOLPH RD, SUITE 800
CHARLOTTE, NC 28207

Mecklenburg County (704) 384-1246

EDWIN T HOLLOWAY M.D.

Emergency Medicine

1900 RANDOLPH RD, STE 900
CHARLOTTE, NC 28207

Mecklenburg County (704) 377-2424

JOHN W RINGWOOD M.D.

Emergency Medicine (Pediatric Emergency Medicine)

1900 RANDOLPH RD, STE 900
CHARLOTTE, NC 28207

Mecklenburg County (704) 377-2424

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brent Deatherage's NPI number?

The NPI number for Brent Deatherage is 1336373257. It was assigned to this individual provider in the NPPES registry on May 6, 2009.

Where is Brent Deatherage located?

Brent Deatherage practices at 1900 Randolph Rd Suite 900, Charlotte, NC 28207. The listed phone number is (704) 377-2424.

What is Brent Deatherage's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Brent Deatherage enrolled in Medicare?

Yes. Brent Deatherage is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Brent Deatherage was last updated on August 10, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.