NPIMap

Individual provider Active NPI

Mark Brady, M.D.

  • Emergency Medicine Physician
  • Springfield, MO
National Provider Identifier
1366439630
Registry record updated Dec 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
R4P95 Issued in MO
Practice address
1423 N Jefferson Ave
Springfield, MO 65802-1917
Phone
(417) 269-6583
Fax
(417) 269-6573
NPI assigned
Oct 3, 2005
Last updated
Dec 27, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X R4P95 MO Primary

Addresses

Primary practice location

1423 N Jefferson Ave
Springfield, MO 65802-1917

Mailing address

PO Box 9007
Springfield, MO 65808-9007
Phone (417) 269-6583

Other identifiers 2

IdentifierTypeStateIssuer
1366439630MedicaidMO
208255000MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040402000072 MO Practitioner - Emergency MedicinePractitioner - Family Practice 5092707604 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Family Practice
Education
University of Arkansas College of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fordland Clinic, Inc.Group PAC ID 5597794552, 10 clinicians
Lester E Cox Medical CentersGroup PAC ID 1254248917, 336 clinicians

Practice addresses (Care Compare)

1059 Barton Dr
Fordland, MO 65652-7350
Phone 41776722732022

3525 S National Ave
Springfield, MO 65807-7310
Phone (417) 269-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.52 of 100Reported as group
Quality
61.64
Promoting interoperability
100
Improvement activities
40
Cost
76.77

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lester E Cox Medical Centers CurrentSince Jun 19, 2012 Accepting new patients
Fordland Clinic, Inc. CurrentSince May 3, 2014 Accepting new patients
Lester E. Cox Medical Centers Current Accepting new patients
Lester E Cox Medical Centers CurrentSince Mar 1, 2018 Accepting new patients
Fordland Clinic, Inc. CurrentSince May 3, 2014 Accepting new patients
Lester E Cox Medical Centers Emergency Medicine CurrentSince Jun 19, 2012 Accepting new patients
Lester E Cox Medical Centers Past Accepting new patients
Ozarks Medical Center Past Accepting new patients
Lester E Cox Medical Centers PastSince Mar 13, 2022 Accepting new patients

Locations

1059 Barton Dr
Fordland, MO 65652
Phone (417) 767-2100

1000 E Primrose St
Ste 360
Springfield, MO 65807
Phone (417) 269-4037

1001 E Primrose St
Springfield, MO 65807
Phone (417) 875-3434

1423 N Jefferson Ave
Springfield, MO 65802
Phone (417) 269-6583

3525 S National Ave
Springfield, MO 65807
Phone (417) 269-9200

3800 S National Ave
Ste 540
Springfield, MO 65807
Phone (417) 269-6262

3801 S National Ave
Springfield, MO 65807
Phone (417) 269-4056

3801 S National Ave
Fl 5
Springfield, MO 65807

3801 S National Ave
Ste 1122
Springfield, MO 65807

Interoperability endpoints

  • Direct secure messaging: mark.brady@cernerdirect.coxhealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Conway Family Clinic, Inc.Conway, MO, CCN 263874 Rural health clinic 5% Or Greater Direct Ownership Interest
Corporate Director		 Aug 29, 1996
Aug 29, 1996

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

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.

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": "1128297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545868800000",
    "number": "1366439630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9007",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658089007",
            "telephone_number": "417-269-6583",
            "fax_number": "417-269-6573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1423 N JEFFERSON AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658021917",
            "telephone_number": "417-269-6583",
            "fax_number": "417-269-6573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADY",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-03",
        "last_updated": "2018-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "R4P95",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366439630",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208255000",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.