Jack Bradley Smith, PA
Individual provider Active NPI Physician Assistant · Oklahoma City, OK
NPI 1528036704 · NPPES record last updated Dec 1, 2025
Key facts
- NPI
- 1528036704
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 1155 (OK)
- Practice address
- 4401 W Memorial Rd
Oklahoma City, OK 73134-1785 - Phone
- (405) 751-4664
- Fax
- (405) 749-4561
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ou Health Partners Inc
Practice addresses (Care Compare)
3025 SW 104TH St
Ou HLTH ER and UC Sokc
Oklahoma City, OK 73159-7036
Phone (405) 300-7740
900 NE 10TH St
Ouhp Family Medicine
Oklahoma City, OK 73104-5420
Phone (572) 244-0065
Hospital & facility affiliations
- Oklahoma Heart Hospital South, LLC
- SSM Health St Anthony Hospital - Oklahoma City
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040325000815 | OK | Practitioner - Physician Assistant | 2466344510 | Reassigns benefits to 7 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1155 | OK | MD | Health Service Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TPG Hospital LLC | Current |
Accepting new patients | |
| Enhanced Wound Care LLC | Current |
Accepting new patients | |
| Ou Health Partners, Inc | Current |
Accepting new patients | |
| Ou Health Partners, Inc | Current |
Accepting new patients | |
| Community Hospital LLC | Past | Accepting new patients | |
| Mercy Health Services Inc. | Past | Accepting new patients | |
| Norstar Emergency Physicians | Past | Accepting new patients | |
| Oklahoma Heart Hospital South LLC | Past | Accepting new patients | |
| Oklahoma Emergency Services PC | Physician Assistant | Past | Accepting new patients |
Locations
6440 Avondale Dr
Ste 20035
Nichols Hills, OK 73116
Phone (918) 231-8724
6440 Avondale Dr
Nichols Hills, OK 73116
901 N Porter Ave
Norman, OK 73071
Phone (405) 307-1500
9204 N May Ave
Oklahoma City, OK 73120
Phone (405) 840-3488
900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230
700 NE 13th St
Oklahoma City, OK 73104
Phone (405) 271-3667
4401 S Western Ave
Oklahoma City, OK 73109
Phone (405) 636-7000
825 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-4864
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1155 | OK | Yes |
Addresses
Primary practice location
4401 W Memorial Rd
Oklahoma City, OK 73134-1785
Mailing address
18432 Wild Horse TRL
Norman, OK 73072-9603
Phone (405) 760-0560
Other practice location 1
1000 N Lee Ave
Oklahoma City, OK 73102-1036
Phone (405) 272-7000
Other practice location 2
5200 E I 240 Service Rd
Oklahoma City, OK 73135-2607
Phone (405) 628-6000
Other practice location 3
4050 W Memorial Rd
Oklahoma City, OK 73120-8382
Phone (405) 608-3800
Other practice location 4
201 S Sara Rd
Mustang, OK 73064-4306
Phone (405) 376-4505
Other practice location 5
2115 Parkview Drive
El Reno, OK 73036-0000
Phone (405) 262-2640
Other practice location 6
13500 S Tulsa Dr
Oklahoma City, OK 73170-9719
Phone (405) 815-5600
Other practice location 7
700 NE 13th St
Oklahoma City, OK 73104-5004
Phone (405) 271-5321
Other practice location 8
13401 N Western Ave
Oklahoma City, OK 73114-1408
Phone (405) 252-3400
Other practice location 9
3400 S Douglas Blvd
Oklahoma City, OK 73150-1001
Phone (405) 815-5600
Other providers in Oklahoma City, OK
- Harrison Smith
- Heather Smith
- Henry Smith
- Herman Smith Jr.
- Holly Diane Smith
- Jacqueline J Smith
- Jaiden Elise Smith
- James Colvin Smith
- James Kyle Smith
- James Wayne Smith
All providers in Oklahoma City, OK · Physician Assistant in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.