Individual provider Active NPI

Jeffry Michael Bryen, PA

  • Physician Assistant
  • Oklahoma City, OK
National Provider Identifier
1265491237
Registry record updated Aug 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
699 Issued in OK
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

Updated by the provider on Aug 6, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
100113870AMedicaidOK

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 LLCGroup PAC ID 0143674465, 17 clinicians

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 100Reported as group
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. Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
699OKMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dynamic Wound Care LLC CurrentSince Jul 26, 2025 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

  • FHIR API: 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.

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

Verify at the official NPI Registry.