Organization Active NPI

R Bruce Parker MD PC

  • Specialist
  • Norman, OK
National Provider Identifier
1558502013
Registry record updated Jun 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
15169 Issued in OK
Legal business name
R BRUCE PARKER MD PC
Practice address
3441 24TH Ave NW Ste 105
Norman, OK 73069-6716
Phone
(405) 321-2929
Fax
(405) 366-8701
NPI assigned
Mar 13, 2009
Last updated
Jun 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2021

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

Authorized official

Name
Russell Bruce Parker, MDNPI 1205844420
Title
Corporation Head
Phone
(405) 321-2929

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 15169 OK Primary

Addresses

Primary practice location

3441 24TH Ave NW Ste 105
Norman, OK 73069-6716

Mailing address

3441 24TH Ave NW Ste 105
Norman, OK 73069-6716
Phone (140) 532-1292

Other identifiers 1

IdentifierTypeStateIssuer
100147560AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090420000432 OK Part B Supplier - Clinic/Group Practice 4183771611 Receives reassigned benefits from 1 practitioner
Practice locations: Norman, OK

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D0947968R Bruce Parker MD3441 24TH Avenue NW, Ste 105, Norman, OK 73069Certificate of waiverJun 28, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1236902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623715200000",
    "number": "1558502013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3441 24TH AVE NW STE 105",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730696716",
            "telephone_number": "140-532-1292",
            "fax_number": "405-366-8701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3441 24TH AVE NW STE 105",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730696716",
            "telephone_number": "405-321-2929",
            "fax_number": "405-366-8701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R BRUCE PARKER MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-13",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "CORPORATION HEAD",
        "authorized_official_telephone_number": "405-321-2929",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "OK",
            "license": "15169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100147560A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norman, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.