NPIMap

Individual provider Active NPI

Bryn Putbrese, M.D.

  • Neuroradiology Physician
  • Temple, TX
National Provider Identifier
1134462716
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuroradiology PhysicianTaxonomy code 2085N0700X
License
U5211 Issued in TX
Practice address
2401 S 31St St
Temple, TX 76508-3641
Phone
(254) 724-2111
NPI assigned
Apr 1, 2013
Last updated
Oct 12, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Neuroradiology Physician 2085N0700X 15653 ND
Neuroradiology Physician 2085N0700X U5211 TX Primary

Addresses

Primary practice location

2401 S 31St St
Temple, TX 76508-3641

Mailing address

PO Box 844658
Dallas, TX 75284-4658
Phone (800) 994-0371

Other practice location 1

801 Broadway N
Fargo, ND 58102-3641
Phone (701) 234-2000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bputbrese1216512@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, TX, ID3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20191025000555 ND Practitioner - Neurology 7416188081 Reassigns benefits to 1 organization
I20230821002162 TX Practitioner - Diagnostic RadiologyPractitioner - Neurology 7416188081
I20251024001676 ID Practitioner - Diagnostic Radiology 7416188081 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of North Dakota School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

801 Broadway N
Fargo, ND 58102-3641
Phone (701) 234-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0125SDMDNeonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo CurrentSince Jul 29, 2019 Accepting new patients
Btdi JV, LLP CurrentSince Jul 11, 2024 Accepting new patients
Sanford Medical Center Fargo CurrentSince Jul 29, 2019 Accepting new patients
North Canyon Medical Center, Inc. CurrentSince Aug 1, 2025 Accepting new patients
North Canyon Medical Center Inc. Current Accepting new patients
Btdi JV, LLP CurrentSince Jul 11, 2024 Accepting new patients
North Canyon Medical Center, Inc. CurrentSince Aug 1, 2025 Accepting new patients
Btdi JV, LLP CurrentSince Jul 1, 2024 Accepting new patients
Btdi JV, LLP CurrentSince Jul 11, 2024 Accepting new patients
Lisbon Area Health Services Past Accepting new patients
Weiser Valley Hospital District Neuroradiology Past Accepting new patients

Locations

267 N Canyon Dr
Gooding, ID 83330
Phone (208) 934-4433

2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800

801 Broadway N
Fargo, ND 58102
Phone (701) 234-2371

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1364774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1134462716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "800-994-0371",
            "fax_number": "254-215-9722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 S 31ST ST",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765083641",
            "telephone_number": "254-724-2111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 Broadway N",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581023641",
            "country_code": "US",
            "telephone_number": "701-234-2000",
            "fax_number": "701-234-2345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUTBRESE",
        "first_name": "BRYN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-01",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "ND",
            "license": "15653",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "TX",
            "license": "U5211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bputbrese1216512@direct.sw.org",
            "affiliation": "N",
            "address_1": "2401 S 31st St",
            "city": "Temple",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765083641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Temple, TX

Sources for this page

Verify at the official NPI Registry.