Bradley John Burket, D.M.D.,M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD19055 Issued in OR

Practice address

2195 NE Professional CT
Ste 1
Bend, OR 97701-6028

Phone

(541) 322-9396

Fax

(541) 322-9398

NPI assigned

Jun 23, 2006

Last updated

Jan 17, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: bburket24403@coipa.gardenplot.direct-ci.com

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.

• Neighborhood Family Medicine

  • Family Medicine Physician
  • Bend, OR
  • NPI 1225831837
  NPD (past)
• Qhsa Dba Dr. Bradley J Burket DMD, MD

  dba Dr. Braldey J Burket DMD, MD

  • Preferred Provider Organization
  • Bend, OR
  • NPI 1538579727
  NPD (past)

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326758400000",
    "number": "1235165325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2195 NE PROFESSIONAL CT",
            "address_2": "STE 1",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016028",
            "telephone_number": "541-322-9396",
            "fax_number": "541-322-9398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2195 NE PROFESSIONAL CT",
            "address_2": "STE 1",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016028",
            "telephone_number": "541-322-9396",
            "fax_number": "541-322-9398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKET",
        "first_name": "BRADLEY",
        "middle_name": "JOHN",
        "credential": "D.M.D.,M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2012-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D6600",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD19055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1156820001",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COIHS",
            "identifier": "100117",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7608077",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "080507",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "002955000",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Burish, PH.D.
• Alan D Burke, LCSW
• Don Gilbert Burke, MD
• Lindsey Burke
• Candy Lynn Burkenbine-Yamaguchi, M.D.
• Hayden Burket
• Jennifer Burkett, LMT
• Chloe Serafina Burkhardt, LPC
• Marie Burkhart
• Amy Burks, LCSW

• Family Medicine Physician in Bend, OR
• Providers in Bend, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.