Brendon Delport, DO

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

2004008249 Issued in MO

Practice address

2828 N National Ave
Springfield, MO 65803-4306

Phone

(417) 837-4003

Fax

(417) 875-4782

NPI assigned

Jun 23, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MO

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 Osteopathy

State licenses

Practice roles

Locations

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.

• Advocates for a Healthy Community, Inc

  • Federally Qualified Health Center (FQHC)
  • Springfield, MO
  • NPI 1558303057
  Medicare reassignment NPD
• Advocates for a Healthy Community Inc

  • Federally Qualified Health Center (FQHC)
  • Buffalo, MO
  • NPI 1750179610
  NPD
• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308182400000",
    "number": "1194721100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2828 N NATIONAL AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658034306",
            "telephone_number": "417-837-4003",
            "fax_number": "417-875-4782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2828 N NATIONAL AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658034306",
            "telephone_number": "417-837-4003",
            "fax_number": "417-875-4782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELPORT",
        "first_name": "BRENDON",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2011-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": "2004008249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194721100",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00261949",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209165604",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Olivia Delamora, M.S., CF-SLP
• Jim A Delamotte, PSY.D., L.P.C.
• Louis Joseph Delcampo, MD
• Robin Melissa Dell, AA-C
• Kevin Delong, PHARMD
• Delta Medical Group Inc
• Matthew John Demers
• Richart Lipe Demier, PH.D.
• Jessica R Demoret, LCSW
• Zarah Denbow

• Ophthalmology Physician in Springfield, MO
• Providers in Springfield, MO by specialty
• Ophthalmology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2011; 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.