Scott W Brodie, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

D8634 Issued in OR

Practice address

305 Shafer LN
Jacksonville, OR 97530-9681

Phone

(541) 899-8833

Fax

(541) 899-1769

NPI assigned

Jan 8, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brodie Dental LLC

  • General Practice Dentistry
  • Jacksonville, OR
  • NPI 1184807331
  NPD (past) Authorized official

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

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199750400000",
    "number": "1609051713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 SHAFER LN",
            "city": "JACKSONVILLE",
            "state": "OR",
            "postal_code": "975309681",
            "telephone_number": "541-899-8833",
            "fax_number": "541-899-1769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 SHAFER LN",
            "city": "JACKSONVILLE",
            "state": "OR",
            "postal_code": "975309681",
            "telephone_number": "541-899-8833",
            "fax_number": "541-899-1769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODIE",
        "first_name": "SCOTT",
        "middle_name": "W",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-01-08",
        "last_updated": "2008-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D8634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Applegate Valley Dental, Inc.
• Autumn D Mercer Agnp-C LLC
• Deborah Luetkenhoelter Benson, M.A./CCC-SLP
• Nastassia Lee-Ann Bird, LMT
• Brodie Dental LLC
• William R. Brodie, D.M.D.
• Joseph Budziszewski, LMT
• Kimberly Ann Caffrey, RN
• Teresa Jayne Connell, LPC, ATR-BC, NCC
• Steven Scott Crowthers, CRNA

• Dentist in Jacksonville, OR
• Providers in Jacksonville, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.