Active NPI
Jeffry Michael Bryen, PA
- Physician Assistant
- Oklahoma City, OK
National Provider Identifier
1265491237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 699
- Practice address
- 2222 Shadowlake Dr BLDG J
Oklahoma City, OK 73159-7440 - Phone
- (405) 554-3344
- Fax
- (405) 694-4547
- NPI assigned
- Mar 20, 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 699 | OK | Primary |
Addresses
Primary practice location
2222 Shadowlake Dr BLDG J
Oklahoma City, OK 73159-7440
Mailing address
PO Box 113
Wanette, OK 74878-0113
Phone (405) 694-6950
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100113870A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031119000517 | OK | Practitioner - Physician Assistant | 7618881962 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dynamic Wound Care LLC
Practice addresses (Care Compare)
2222 Shadowlake Dr
Oklahoma City, OK 73159-7440
Phone (405) 554-3344
Merit-based Incentive Payment System (MIPS)
- Final score
- 84.12 of 100
- Quality
- 71.48
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 75.58
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 699 | OK | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dynamic Wound Care LLC | Current | Accepting new patients | |
| Baptist Healthcare of Oklahoma, Inc | Past | Accepting new patients | |
| Today Clinic Texas PLLC | Past | Accepting new patients | |
| Verdure Health Services | Past | Accepting new patients | |
| Baptist Healthcare of Oklahoma Inc | Past | Accepting new patients | |
| Jackson County Memorial Hospital Authority | Past | Accepting new patients |
Locations
1101 SW 30th Ct
#A
Moore, OK 73160
2222 Shadowlake Dr
Bldg J
Oklahoma City, OK 73159
Phone (405) 554-3344
2222 Shadowlake Dr
Oklahoma City, OK 73159
Phone (405) 315-8440
Interoperability endpoints
- https://api.platform.athenahealth.com/17053/brand/1/csg/1/fhir/r4
Organizations & group practices 6
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.
-
- Community Based Hospice Care Agency
- Madill, OK
- NPI 1124040217
-
- Home Health Agency
- Madill, OK
- NPI 1639192727
-
- General Acute Care Hospital
- Altus, OK
- NPI 1093763781
-
- Primary Care Clinic/Center
- Lewisville, TX
- NPI 1033583984
-
- Family Medicine Physician
- Irving, TX
- NPI 1801495940
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785974400000",
"number": "1265491237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 113",
"city": "WANETTE",
"state": "OK",
"postal_code": "748780113",
"telephone_number": "405-694-6950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2222 SHADOWLAKE DR BLDG J",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731597440",
"telephone_number": "405-554-3344",
"fax_number": "405-694-4547"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRYEN",
"first_name": "JEFFRY",
"middle_name": "MICHAEL",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-20",
"last_updated": "2026-08-06",
"certification_date": "2026-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OK",
"license": "699",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100113870A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.