Brent Wade Davis, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1913 Issued in OK

Practice address

315 W. 9 Street
Weleetka, OK 74880-0337

Phone

(405) 786-2248

Fax

(405) 786-2006

NPI assigned

Mar 12, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://epicproxy.ardenthealth.com/fhir/UPC/api/FHIR/R4

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Family Clinic of Weleetka

  • Rural Health Clinic/Center
  • Weleetka, OK
  • NPI 1699953687

  5% Or Greater Direct Ownership Interest

  CMS ownership

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.

• Ahs Henryetta Hospital LLC

  • General Acute Care Hospital
  • Henryetta, OK
  • NPI 1720053556
  NPD (past)
• Ahs Oklahoma Physician Group LLC

  • Family Medicine Physician
  • Tulsa, OK
  • NPI 1235182775
  NPD (past)
• Family Clinic of Weleetka

  • Rural Health Clinic/Center
  • Weleetka, OK
  • NPI 1699953687
  NPD (past)
• Sanderson Health Center LLC

  • Rural Health Clinic/Center
  • Weleetka, OK
  • NPI 1710842232
  NPD (past)
• Satwant Tandon MD PC

  • Specialist
  • Henryetta, OK
  • NPI 1578744348
  NPD (past)

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310083200000",
    "number": "1619009859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207",
            "city": "HENRYETTA",
            "state": "OK",
            "postal_code": "744370207",
            "telephone_number": "405-786-2248",
            "fax_number": "405-786-2006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W. 9 STREET",
            "city": "WELEETKA",
            "state": "OK",
            "postal_code": "748800337",
            "telephone_number": "405-786-2248",
            "fax_number": "405-786-2006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "BRENT",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-12",
        "last_updated": "2011-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "1913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100743630A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100743630B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aspen Place Living Center, LLC
• Katie Nicole Burden-Greer
• Adrianne Elizabeth Collett
• Amber Lynn Doerr
• Family Clinic of Weleetka
• Graham Public School
• Cady Ann Marshall
• Med-Econ Drug Inc

• Family Medicine Physician in Weleetka, OK
• Providers in Weleetka, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.