Bradley Todd Anderson, DO
Individual provider Active NPI Family Medicine Physician · Coweta, OK
NPI 1023058757 · NPPES record last updated Jan 5, 2010
Key facts
- NPI
- 1023058757
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 3893 (OK)
- Practice address
- 28622 E 141St St S
Coweta, OK 74429-7515 - Phone
- (918) 486-7425
- Fax
- (918) 279-6884
- NPI assigned
- Jun 8, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 10
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Oklahoma State University College of Osteopathic Medicine, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Coweta Medical Group,P.L.L.C.
Practice addresses (Care Compare)
28622 E 141St S St
Coweta, OK 74429-7515
Phone (918) 486-7425
28622 E 141St St S
Coweta, OK 74429-7515
Hospital & facility affiliations
- Vitalcaring Group
- Complete Home Health of Western Oklahoma
- Millennium Hospice, Inc
- Saint Francis Hospital South, LLC
- Hillcrest Hospital South
- Saint Francis Hospital Muskogee
- Saint Francis Hospital, Inc
- Ascension St John Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040524000871 | OK | Practitioner - Family Practice |
2062403371 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3893 | OK | MD | Family Medicine Physician |
| 3983 | OK | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coweta Medical Group,P.L.L.C. | Current |
Accepting new patients | |
| Urgent Care of Green Country PLLC | Past | Accepting new patients |
Locations
28622 E 141st St S
Coweta, OK 74429
Phone (918) 486-7425
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 3893 | OK | Yes |
Addresses
Primary practice location
28622 E 141St St S
Coweta, OK 74429-7515
Mailing address
28622 E 141St St S
PO Box 1030
Coweta, OK 74429-7515
Phone (918) 486-7425
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100126410A | Medicaid | OK |
Other providers in Coweta, OK
- Abs Foundations ABA Specialists LLC
- Advanced Family Eye Care Inc
- Bilal Ahmed
- Jack Stephen Aldridge
- Allen S Braumiller Jr DDS PC
- Kyle A Anderson
- Arkansas Verdigris Valley Health Centers, Inc.
- Kylee Nicole Armstrong
- Boerje A. Axelsson
- Jeffery Allen Barentine
All providers in Coweta, OK · Family Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.