BRENDEN G TULLY PA
NPI 1720765969
Physician Assistant in Ashtabula, OH

Active since June 29, 2023PECOS EnrolledAccepts Medicare Assignment
2420 LAKE AVE, ASHTABULA, OH 44004(440) 997-2262 Get Directions Write a Review

NPPES record last updated: October 10, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Brenden G Tully Pa NPPES

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

BRENDEN G TULLY PA (NPI 1720765969) is an individual physician assistant in Ashtabula, Ohio, licensed in Ohio (50.008422RX) and active in the NPI registry since June 2023. He is enrolled in Medicare PECOS, is affiliated with Summa Western Reserve Hospital, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1720765969
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameBRENDEN G TULLYCredential: PA
Location Address2420 LAKE AVEAshtabula, OH 44004-4954
Mailing Address411 Castle Rock RdBrookfield, OH 44403-8603 · (330) 413-7913
Sole ProprietorYes
Medical School CMSOtherGraduated 2023
Enumeration DateJune 29, 2023
Last NPPES UpdateOctober 10, 2023
NPPES CertifiedOctober 10, 2023
NPI 1720765969 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License Licensed in OH · 50.008422RX
Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

2420 LAKE AVE, Ashtabula, OH 44004

Accepted Insurance

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

Brenden G Tully Pa 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 ID3971959149
PECOS Enrollment IDI20231024002114
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.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Summa Western Reserve Hospital

Acute Care Hospitals · Cuyahoga Falls, OH
4/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number360150
Location1900 23rd StreetCuyahoga Falls, OH 44223 · Summit County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 44004 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.72 typical visit price
range $54.34 – $166.65
Typical copayment $21.18 (range $13.58 – $41.66)
Most-billed visit code 99203
Established Patient
$68.07 typical visit price
range $17.10 – $135.40
Typical copayment $17.01 (range $4.27 – $33.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

Internal Medicine (Hematology & Oncology)
2420 LAKE AVE
ASHTABULA, OH 44004
Emergency Medicine
2420 LAKE AVE
ASHTABULA, OH 44004
Emergency Medicine
2420 LAKE AVE
ASHTABULA, OH 44004
Emergency Medicine
2420 LAKE AVE
ASHTABULA, OH 44004
Physician Assistant
2420 LAKE AVE
ASHTABULA, OH 44004
Personal Emergency Response Attendant
2420 LAKE AVE
ASHTABULA, OH 44004
Specialist
2420 LAKE AVE
ASHTABULA, OH 44004
Internal Medicine
2420 LAKE AVE
ASHTABULA, OH 44004

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1720765969, enumerated as an "individual" on June 29, 2023.

The provider is located at 2420 LAKE AVE ASHTABULA, OH 44004 and the phone number is (440) 997-2262.

Physician Assistant with taxonomy code 363A00000X.

The provider might be accepting Accepts: CareSource. Please consult your insurance carrier or call the provider to verify.

Brenden Tully is affiliated with: SUMMA WESTERN RESERVE HOSPITAL.