NPIMap

Individual provider Active NPI

Brian Graham, PA

  • Surgical Physician Assistant
  • Tulsa, OK
National Provider Identifier
1528254505
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
1670 Issued in OK
Practice address
2431 E 61St St Ste 500
Tulsa, OK 74136-1208
Phone
(918) 582-6800
Fax
(918) 582-6060
NPI assigned
Sep 24, 2007
Last updated
Nov 12, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 1670 OK Primary

Addresses

Primary practice location

2431 E 61St St Ste 500
Tulsa, OK 74136-1208

Mailing address

2431 E 61St St Ste 500
Tulsa, OK 74136-1208
Phone (918) 582-6800

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
I20080320000242 OK Practitioner - Physician Assistant 2062598741 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopaedic Center PCGroup PAC ID 8123915626, 19 clinicians

Practice addresses (Care Compare)

2431 E 61St St
Suite 500
Tulsa, OK 74136-1208
Phone (918) 582-6800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1670OKMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Center, PC CurrentSince Sep 1, 2007 Accepting new patients
Orthopaedic Center, PC CurrentSince Sep 1, 2007 Accepting new patients
Osu Health System Anesthesia Past Accepting new patients
St John Sapulpa, Inc. Past Accepting new patients

Locations

2431 E 61st St
Ste 500
Tulsa, OK 74136
Phone (918) 925-3243

Organizations & group practices 4

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 9

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": "1190592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1528254505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2431 E 61ST ST STE 500",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741361208",
            "telephone_number": "918-582-6800",
            "fax_number": "918-582-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2431 E 61ST ST STE 500",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741361208",
            "telephone_number": "918-582-6800",
            "fax_number": "918-582-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "BRIAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-24",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OK",
            "license": "1670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.