NPIMap

Individual provider Active NPI

Anna Elizabeth Braddock, PA-C

  • Physician Assistant
  • Springfield, OR
National Provider Identifier
1578205092
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA211508 Issued in OR
Practice address
2400 Hartman LN
Springfield, OR 97477-1118
Phone
(541) 334-3350
NPI assigned
Apr 13, 2022
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA211508 OR Primary

Addresses

Primary practice location

2400 Hartman LN
Springfield, OR 97477-1118

Mailing address

2400 Hartman LN
Springfield, OR 97477-1118
Phone (541) 334-3350

Other identifiers 1

IdentifierTypeStateIssuer
PA211508OtherOROREGON MEDICAL BOARD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, OK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220707003539 OR Practitioner - Physician Assistant 5799165759 Reassigns benefits to 1 organization
I20240802000484 OK Practitioner - Physician Assistant 5799165759 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saints Medical Group, LLCGroup PAC ID 7012914898, 430 clinicians

Practice addresses (Care Compare)

1000 N Lee Ave
Oklahoma City, OK 73102-1036
Phone (405) 272-7000

608 NW 9TH St
Oklahoma City, OK 73102-1049

608 NW 9TH St
Oklahoma City, OK 73102-1068

608 NW 9TH St
Suite 5010
Oklahoma City, OK 73102-1058
Phone (405) 772-4533

608 NW 9TH St
Suite 6000
Oklahoma City, OK 73102-1041
Phone (405) 772-4533

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.57 of 100Reported as group
Quality
93.49
Promoting interoperability
100
Improvement activities
40
Cost
61.74

Merit-based Incentive Payment System (MIPS)

Final score
82.68 of 100Reported as group
Quality
73.02
Promoting interoperability
80
Improvement activities
40
Cost
85.92

Merit-based Incentive Payment System (MIPS)

Final score
85.96 of 100Reported as group
Quality
80.43
Promoting interoperability
100
Improvement activities
40
Cost
72.76

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA211508ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saints Medical Group, LLC CurrentSince Jun 14, 2024 Accepting new patients
SSM Health Care of Oklahoma, Inc. Past Accepting new patients

Locations

608 NW 9th St
Ste 2200
Oklahoma City, OK 73102
Phone (405) 231-3737

Interoperability endpoints

  • Direct secure messaging: abraddoc@yourcarecommunity.org
  • Direct secure messaging: abraddock396910@direct-ehr-ssmhc.com

Organizations & group practices 3

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 5

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": "1649808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1578205092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 HARTMAN LN",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771118",
            "telephone_number": "541-334-3350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 HARTMAN LN",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771118",
            "telephone_number": "541-334-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADDOCK",
        "first_name": "ANNA",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-13",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA211508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON MEDICAL BOARD",
            "identifier": "PA211508",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OR

Sources for this page

Verify at the official NPI Registry.