NPIMap

Organization Active NPI

Qhsa Dba Dr. Bradley J Burket DMD, MD

  • Preferred Provider Organization
  • Bend, OR
National Provider Identifier
1538579727
Registry record updated Apr 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
MD19055 Issued in OR
Legal business name
QHSA DBA DR. BRADLEY J BURKET DMD, MD
Practice address
2195 NE Professional CT Ste 1
Bend, OR 97701-6028
Phone
(541) 322-9396
Fax
(541) 322-9398
NPI assigned
Apr 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2014

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

Authorized official

Name
Miss Misty Boughton
Title
Office Manager
Phone
(541) 322-0376

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X MD19055 OR Primary

Addresses

Primary practice location

2195 NE Professional CT Ste 1
Bend, OR 97701-6028

Mailing address

2195 NE Professional CT Ste 1
Bend, OR 97701-6028
Phone (541) 322-9396

Other identifiers 1

IdentifierTypeStateIssuer
000BLBYFMedicaidOR

Other names 1

  • Dr. Braldey J Burket DMD, MD Doing business as

National Provider Directory

National Provider Directory

Locations

2195 NE Professional Ct
Ste 1
Bend, OR 97701
Phone (541) 322-9396

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1398643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398643200000",
    "number": "1538579727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2195 NE PROFESSIONAL CT STE 1",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016028",
            "telephone_number": "541-322-9396",
            "fax_number": "541-322-9398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2195 NE PROFESSIONAL CT STE 1",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016028",
            "telephone_number": "541-322-9396",
            "fax_number": "541-322-9398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QHSA DBA DR. BRADLEY J BURKET DMD, MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-28",
        "last_updated": "2014-04-28",
        "status": "A",
        "authorized_official_last_name": "BOUGHTON",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "541-322-0376",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "OR",
            "license": "MD19055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000BLBYF",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Braldey J Burket DMD, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2014; 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.