Active NPI
Dagan M Breakfield III, CRNP
- Obstetrics & Gynecology Physician
- Madison, AL
National Provider Identifier
1154919736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- MD33350
- Practice address
- 3825 Sullivan Street
Suite 2
Madison, AL 35758 - Phone
- (256) 692-7492
- Fax
- (833) 791-1682
- NPI assigned
- Jan 8, 2021
- Last updated
- Nov 14, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | F01210174 | AL | |
| Obstetrics & Gynecology Physician | 207V00000X | MD33350 | AL | Primary |
Addresses
Primary practice location
3825 Sullivan Street
Suite 2
Madison, AL 35758
Mailing address
3825 Sullivan Street
Suite 2
Madison, AL 35758
Phone (256) 692-7492
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD33350 | Medicaid | AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD33350 | AL | MD | Obstetrics & Gynecology Physician |
| F01210174 | AL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinic for Women PA | Past | Accepting new patients | |
| Clinic for Women, P.a. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Specialist
- Madison, AL
- NPI 1629225172
-
- Specialist
- Madison, AL
- NPI 1831346121
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731542400000",
"number": "1154919736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3825 SULLIVAN STREET",
"address_2": "SUITE 2",
"city": "MADISON",
"state": "AL",
"postal_code": "35758",
"telephone_number": "256-692-7492",
"fax_number": "833-791-1682"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3825 SULLIVAN STREET",
"address_2": "SUITE 2",
"city": "MADISON",
"state": "AL",
"postal_code": "35758",
"telephone_number": "256-692-7492",
"fax_number": "833-791-1682"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREAKFIELD",
"first_name": "DAGAN",
"middle_name": "M",
"name_suffix": "III",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-01-08",
"last_updated": "2024-11-14",
"certification_date": "2024-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AL",
"license": "F01210174",
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "AL",
"license": "MD33350",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "MD33350",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Madison, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.