NPIMap

Individual provider Active NPI

Bryan Treacy, MD

  • Obstetrics Physician
  • Moore, OK
National Provider Identifier
1356339360
Registry record updated Mar 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics PhysicianTaxonomy code 207VX0000X
License
23781 Issued in OK
Practice address
1035 SW 19TH St
Suite B
Moore, OK 73160-2883
Phone
(405) 793-9171
Fax
(405) 793-0815
NPI assigned
Oct 12, 2005
Last updated
Mar 30, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 30, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics Physician 207VX0000X 23781 OK Primary

Addresses

Primary practice location

1035 SW 19TH St
Suite B
Moore, OK 73160-2883

Mailing address

PO Box 6847
Moore, OK 73153-0847
Phone (405) 793-9171

Other identifiers 1

IdentifierTypeStateIssuer
200036180AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
23781OKMDObstetrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Clinton Hma, LLC Past Accepting new patients
Rha Stroud Inc Past Accepting new patients
PLW Anesthesia LLC Past Accepting new patients
Moore Medical Center, LLC Past Accepting new patients
Midwest City Hma Physician Management, LLC Past Accepting new patients

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269907200000",
    "number": "1356339360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6847",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731530847",
            "telephone_number": "405-793-9171",
            "fax_number": "405-793-0815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 SW 19TH ST",
            "address_2": "SUITE B",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731602883",
            "telephone_number": "405-793-9171",
            "fax_number": "405-793-0815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TREACY",
        "first_name": "BRYAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2010-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "OK",
            "license": "23781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200036180A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moore, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2010; 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.