Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Brenden G Tully, PA

Individual provider Physician Assistant · NPI 1720765969

Brenden G Tully, PA is a Physician Assistant in Ashtabula, Ohio. Qualified in 2023, 3 years ago. Practices with Bloomington Medical Services LLC, a 106-clinician group and accepts Medicare assignment. Licensed in Ohio.

Years since qualifying
3
Licensed in
OH
In the registry since
2023
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

2420 Lake Ave
Ashtabula, OH 44004-4954
Phone: (440) 997-2262
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 50.008422RX (OH)

Record details

NPI number1720765969
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedJune 29, 2023
Last updated in NPPESOctober 10, 2023
Certification dateOctober 10, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Bloomington Medical Services Llc — 106 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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