Active NPI
Bruce D Pendleton, MD
- Neurological Surgery Physician
- Enid, OK
National Provider Identifier
1194735407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurological Surgery Physician
- License
- 13141
- Practice address
- 620 S Madison St
Suite 202
Enid, OK 73701-7273 - Phone
- (580) 616-7605
- Fax
- (580) 616-7626
- NPI assigned
- Aug 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | 13141 | OK | Primary |
Addresses
Primary practice location
620 S Madison St
Suite 202
Enid, OK 73701-7273
Mailing address
PO Box 960394
Oklahoma City, OK 73196-0001
Phone (580) 548-1367
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100824270B | Medicaid | OK |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13141 | OK | MD | Neurological Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integris Rural Health, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Family Physicians of the Plains
- Family Medicine Physician
- Enid, OK
- NPI 1710113121
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290556800000",
"number": "1194735407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 960394",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731960001",
"telephone_number": "580-548-1367",
"fax_number": "580-548-1583"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 S MADISON ST",
"address_2": "SUITE 202",
"city": "ENID",
"state": "OK",
"postal_code": "737017273",
"telephone_number": "580-616-7605",
"fax_number": "580-616-7626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDLETON",
"first_name": "BRUCE",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2010-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "207T00000X",
"taxonomy_group": "",
"desc": "Neurological Surgery",
"state": "OK",
"license": "13141",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100824270B",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Enid, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.