Individual provider Active NPI

Lawrence Clay Brotherton III, MD

  • Surgery Physician
  • Tulsa, OK
National Provider Identifier
1144218322
Registry record updated Jul 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
24398 Issued in OK
Practice address
1725 E 19TH St
Suite 800
Tulsa, OK 74104-5472
Phone
(918) 301-2505
Fax
(918) 744-3633
NPI assigned
Oct 11, 2005
Last updated
Jul 26, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 24398 OK Primary

Addresses

Primary practice location

1725 E 19TH St
Suite 800
Tulsa, OK 74104-5472

Mailing address

1725 E 19TH St
Suite 800
Tulsa, OK 74104-5472
Phone (918) 301-2505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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

Enrollment IDStateProvider typePAC IDDetails
I20051031000267 OK Practitioner - General Surgery 5294773685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Kansas School of Med (KC/Wich/Sal), 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. John Physicians, Inc.Group PAC ID 2567366495, 262 clinicians

Practice addresses (Care Compare)

12455 E 100TH St N
Suite 220
Owasso, OK 74055-4675
Phone (918) 274-5555

1705 E 19TH St
Tulsa, OK 74104-5410

1919 S Wheeling Ave
Tulsa, OK 74104-5634

1923 S Utica Ave
Tulsa, OK 74104-6520
Phone (918) 744-2071

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy27
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
24398OKMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc CurrentSince Jul 29, 2020 Accepting new patients
St. John Physicians, Inc. Current Accepting new patients
Owasso Medical Facility, Inc Past Accepting new patients
St John Medical Center Inc Past Accepting new patients

Locations

12455 E 100th St N
Owasso, OK 74055
Phone (918) 272-9464

12455 E 100th St N
Ste 220
Owasso, OK 74055
Phone (918) 274-5555

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

1705 E 19th St
Ste 304
Tulsa, OK 74104
Phone (918) 748-7660

1725 E 19th St
Ste 800
Tulsa, OK 74104
Phone (918) 301-2505

1919 S Wheeling Ave
Ste 504
Tulsa, OK 74104
Phone (918) 747-8071

Interoperability endpoints

  • Direct secure messaging: lawrence.brotherton@direct.stjohnhealthsystem.com

Organizations & group practices 4

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 3

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": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311638400000",
    "number": "1144218322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1725 E 19TH ST",
            "address_2": "SUITE 800",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045472",
            "telephone_number": "918-301-2505",
            "fax_number": "918-744-3633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1725 E 19TH ST",
            "address_2": "SUITE 800",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045472",
            "telephone_number": "918-301-2505",
            "fax_number": "918-744-3633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROTHERTON",
        "first_name": "LAWRENCE",
        "middle_name": "CLAY",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-11",
        "last_updated": "2011-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OK",
            "license": "24398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.