NPIMap

Individual provider Active NPI

Breanna J Brumley, PA-C

  • Medical Physician Assistant
  • Tulsa, OK
National Provider Identifier
1508168964
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1999 Issued in OK
Practice address
9709 E 79TH St
Tulsa, OK 74133-4566
Phone
(918) 994-4000
NPI assigned
Nov 17, 2010
Last updated
Sep 28, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PT2020-062 AR
Medical Physician Assistant 363AM0700X 1999 OK Primary

Addresses

Primary practice location

9709 E 79TH St
Tulsa, OK 74133-4566

Mailing address

9709 E 79TH St
Tulsa, OK 74133-4566
Phone (918) 994-4000

Other names 1

  • Breanna J Walker Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20110713000418 OK Practitioner - Physician Assistant 1557539830 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Invictus Healthcare System PLLCGroup PAC ID 2264755925, 4 clinicians

Practice addresses (Care Compare)

9709 E 79TH St
Tulsa, OK 74133-4566
Phone (918) 994-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1999OKMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Tulsa Orthopedic Surgeons Past Accepting new patients

Organizations & group practices 2

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 8

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": "1289952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1508168964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9709 E 79TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741334566",
            "telephone_number": "918-994-4000",
            "fax_number": "918-994-4090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9709 E 79TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741334566",
            "telephone_number": "918-994-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUMLEY",
        "first_name": "BREANNA",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-17",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AR",
            "license": "PT2020-062",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "1999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BREANNA",
            "last_name": "WALKER",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.