NPIMap

Individual provider Active NPI

Brette Camerann Harding, MD

  • Otolaryngology Physician
  • Springfield, IL
National Provider Identifier
1346760105
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
036.165831 Issued in IL
Practice address
720 N Bond St
Springfield, IL 62702-4952
Phone
(217) 545-8000
Fax
(217) 545-0253
NPI assigned
Jun 22, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 2017019818 MO
Otolaryngology Physician 207Y00000X 036.165831 IL Primary

Addresses

Primary practice location

720 N Bond St
Springfield, IL 62702-4952

Mailing address

PO Box 19639
Springfield, IL 62794-9639
Phone (217) 545-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, IL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220808001351 TX Practitioner - Otolaryngology 8921378555 Reassigns benefits to 1 organization
I20230801004397 IL Practitioner - Otolaryngology 8921378555 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Eastern Virginia Medical School, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Siu Physicians and Surgeons IncGroup PAC ID 2365352820, 316 clinicians

Practice addresses (Care Compare)

720 N Bond St
Springfield, IL 62702-4952
Phone (217) 545-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.165831ILMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Jul 1, 2022 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Jul 24, 2023 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Jul 24, 2023 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Otolaryngology CurrentSince Jul 1, 2022 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Siu Physicians & Surgeons, Inc Past Accepting new patients

Locations

720 N Bond St
Springfield, IL 62702
Phone (217) 545-4777

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

5184 Tex Oak Ave
Dallas, TX 75235
Phone (214) 590-6120

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

5303 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390
Phone (214) 645-2300

2001 Inwood Rd
Ut Southwest Medical Center, TX 75390
Phone (214) 645-8000

Interoperability endpoints

  • Direct secure messaging: bretteharding@siusm.allscriptsdirect.net

Organizations & group practices 8

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.

Hospital & facility affiliations 3

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": "1498089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1346760105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19639",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949639",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 N BOND ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024952",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-0253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDING",
        "first_name": "BRETTE",
        "middle_name": "CAMERANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-22",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MO",
            "license": "2017019818",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "036.165831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.