NPIMap

Individual provider Active NPI

Brendon Dean McCollom, DO

  • Family Medicine Physician
  • Oklahoma City, OK
National Provider Identifier
1225256282
Registry record updated Apr 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4315 Issued in OK
Practice address
5201 W Memorial Rd
Oklahoma City, OK 73142-2004
Phone
(405) 755-4050
Fax
(405) 749-9566
NPI assigned
Apr 23, 2007
Last updated
Apr 24, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4315 OK Primary

Addresses

Primary practice location

5201 W Memorial Rd
Oklahoma City, OK 73142-2004

Mailing address

5201 W Memorial Rd
Oklahoma City, OK 73142-2004
Phone (405) 755-4050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071030000138 OK Practitioner - Family Practice 1759478373 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Kansas City University of Physicians and Surgeons, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saints Medical Group, LLCGroup PAC ID 7012914898, 430 clinicians

Practice addresses (Care Compare)

609 W Memorial Rd
Oklahoma City, OK 73114-2006
Phone (405) 418-5400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Logan County Inc Current Accepting new patients
Spire Medical Consulting Family Medicine Current Accepting new patients
Mercy Clinic Oklahoma Communities Family Medicine CurrentSince Jan 1, 2011 Accepting new patients
Mercy Hospital Logan County, Inc CurrentSince May 1, 2015 Accepting new patients
SSM Health Care of Oklahoma, Inc. Past Accepting new patients
Summit Medical Center Past Accepting new patients
Pathways Professional Counseling LLC PastSince Jun 28, 2020 Accepting new patients
Mercy Health Services Inc. Past Accepting new patients

Locations

18503 N Portland Ave
Edmond, OK 73012
Phone (405) 531-4271

200 S Academy Rd
Guthrie, OK 73044
Phone (405) 260-4165

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

8325 NW Expressway
Oklahoma City, OK 73162
Phone (405) 728-8000

5201 W Memorial Rd
Oklahoma City, OK 73142
Phone (405) 755-4050

609 W Memorial Rd
Oklahoma City, OK 73114
Phone (405) 418-2676

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

Interoperability endpoints

  • Direct secure messaging: bmccollom5144@directc.mercy.net
  • Direct secure messaging: bmccollom529638@direct-ehr-ssmhc.com

Organizations & group practices 9

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 4

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": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429833600000",
    "number": "1225256282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 W MEMORIAL RD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731422004",
            "telephone_number": "405-755-4050",
            "fax_number": "405-749-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 W MEMORIAL RD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731422004",
            "telephone_number": "405-755-4050",
            "fax_number": "405-749-9566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOLLOM",
        "first_name": "BRENDON",
        "middle_name": "DEAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2015-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "4315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.