Clark Wesley Brazil, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

E1512 Issued in TX

Practice address

1508 10TH St
Wichita Falls, TX 76301-4401

Phone

(940) 322-6671

Fax

(940) 322-6676

NPI assigned

Nov 17, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: cbrazil13449@unitedregional.medalliesdirect.net
• FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/fhir/r4/
• FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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.

• United Regional Health Care System Inc

  • General Acute Care Hospital
  • Wichita Falls, TX
  • NPI 1023013448
  NPD
• KTX Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Wichita Falls, TX
  • NPI 1013194554
  NPD (past)

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365724800000",
    "number": "1073595708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1508 10TH ST",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763014401",
            "telephone_number": "940-322-6671",
            "fax_number": "940-322-6676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 10TH ST",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763014401",
            "telephone_number": "940-322-6671",
            "fax_number": "940-322-6676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAZIL",
        "first_name": "CLARK",
        "middle_name": "WESLEY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2013-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "TX",
            "license": "E1512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1281834-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Braden Partners LP
• Bradley E. Samuelson, MD PA
• Allen Brajer, M.D.
• Lucille McManis Brandon, PT
• Lashawna April Brandt, COTA
• Breaking Barriers Therapy Center
• Breion Tafoya DO PLLC
• Anna M Brenson, MS, CCC-SLP
• Brett May MD PA
• Judith L Brewer, FNP-C

• Vascular Surgery Physician in Wichita Falls, TX
• Providers in Wichita Falls, TX by specialty
• Vascular Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.