Active NPI
Brayderik Consulting
- Primary Podiatric Medicine Podiatrist
- Tahlequah, OK
National Provider Identifier
1235677121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Podiatric Medicine Podiatrist
- Legal business name
- BRAYDERIK CONSULTING
- Practice address
- 1607 S Muskogee Ave Ste C
Tahlequah, OK 74464-5440 - Phone
- (918) 931-7232
- NPI assigned
- Feb 10, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Paula J Young
- Title
- Ceo
- Phone
- (918) 931-7232
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | |||
| Primary Podiatric Medicine Podiatrist | 213EP1101X | Primary |
Addresses
Primary practice location
1607 S Muskogee Ave Ste C
Tahlequah, OK 74464-5440
Mailing address
807 W Downing St
Tahlequah, OK 74464-2719
Phone (918) 931-7232
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170919003598 | OK | Part B Supplier - Clinic/Group Practice | 8224302948 |
Receives reassigned benefits from 5 practitioners Practice locations: Tahlequah, OK |
National Provider Directory
National Provider DirectoryPractitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Park Hill, OK
- NPI 1356532022
OK, Single Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486684800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1624492800000",
"number": "1235677121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "807 W DOWNING ST",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744642719",
"telephone_number": "918-931-7232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1607 S MUSKOGEE AVE STE C",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744645440",
"telephone_number": "918-931-7232"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BRAYDERIK CONSULTING",
"organizational_subpart": "NO",
"enumeration_date": "2017-02-10",
"last_updated": "2021-06-24",
"certification_date": "2021-06-24",
"status": "A",
"authorized_official_last_name": "YOUNG",
"authorized_official_first_name": "PAULA",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "918-931-7232"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "General Practice",
"state": null,
"license": null,
"primary": false
},
{
"code": "213EP1101X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Podiatrist, Primary Podiatric Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tahlequah, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.