Individual provider Active NPI

Breanna Kay Carlson, DO

  • Emergency Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1194395582
Registry record updated May 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
8116 Issued in OK
Practice address
4212 N 16TH St
Phoenix, AZ 85016-5319
Phone
(602) 263-1200
Fax
(602) 263-1619
NPI assigned
Jun 28, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 8116 OK Primary

Addresses

Primary practice location

4212 N 16TH St
Phoenix, AZ 85016-5319

Mailing address

PO Box 95460
Cleveland, OH 44101-0033
Phone (602) 581-6076

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250123001146 TX Practitioner - Emergency Medicine 2961931746 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Oklahoma State University College of Osteopathic Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dhew Ind HLTH SV HLTH SVS and MNTL HLTH AdmGroup PAC ID 1759290901, 219 clinicians

Practice addresses (Care Compare)

4212 N 16TH St
Phoenix, AZ 85016-5319
Phone (602) 263-1200

Hospital & facility affiliations

  • Phoenix Indian Medical Center Hospital, Phoenix, AZ, CCN 030078

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8116OKMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Chickasaw Nation Division of Health CurrentSince Jan 15, 2025 Accepting new patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Aug 5, 2025 Accepting new patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Aug 5, 2025 Accepting new patients
Chickasaw Nation Division of Health CurrentSince Jan 15, 2025 Accepting new patients
Chickasaw Nation Division of Health Past Accepting new patients

Locations

4212 N 16th St
Phoenix, AZ 85016
Phone (602) 248-4187

1921 Stonecipher Dr
Ada, OK 74820
Phone (580) 421-4570

2510 Chickasaw Blvd
Ardmore, OK 73401
Phone (580) 226-8181

1438 Hardcastle Blvd
Purcell, OK 73080
Phone (405) 527-4700

817 E 6th St
Tishomingo, OK 73460
Phone (580) 371-2392

Interoperability endpoints

  • Direct secure messaging: bcarlson576607@ahs.direct-ci.com
  • Direct secure messaging: bcarlson28211@direct.chickasawnationhealth.net

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778112000000",
    "number": "1194395582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95460",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441010033",
            "telephone_number": "602-581-6076",
            "fax_number": "602-263-1619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 N 16TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165319",
            "telephone_number": "602-263-1200",
            "fax_number": "602-263-1619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "BREANNA",
        "middle_name": "KAY",
        "name_prefix": "Mrs.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-28",
        "last_updated": "2026-05-07",
        "certification_date": "2026-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "8116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.