NPIMap

Organization Active NPI

Bradley Bibb MD PLLC

  • Rural Health Clinic/Center
  • El Reno, OK
National Provider Identifier
1669289310
Registry record updated Aug 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BRADLEY BIBB MD PLLC
Practice address
2400 S Country Club Rd
El Reno, OK 73036-5801
Phone
(405) 276-3800
Fax
(405) 276-3912
NPI assigned
Dec 16, 2024
Last updated
Aug 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2025

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

Authorized official

Name
Monya York
Title
Director Credentialing
Phone
(870) 856-1202

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

2400 S Country Club Rd
El Reno, OK 73036-5801

Mailing address

4196 Highway 62 412 Ste a
Hardy, AR 72542-8002
Phone (870) 856-1202

Other names 1

  • Access Medical Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240520001147 OK Part B Supplier - Clinic/Group Practice 4789715285 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: El Reno, OK; Ponca City, OK
O20250605000839 OK Part A Provider - Rural Health Clinic 4789715285 Practice locations: El Reno, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669289310. Details of each certification follow.

Rural health clinic certification: CCN 373915

Legal name
BRADLEY BIBB MD PLLC
Doing business as
ACCESS MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 12, 2025
Last certification
Aug 12, 2025
Ownership / control type
1A
Organization structure
LLCProprietary
Enrollment address
2400 S Country Club Rd
El Reno, OK 73036-5801

Other NPIs with the same Medicare PAC ID 12

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Access Medical Clinic8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mark Hahn Individual 5% Or Greater Direct Ownership InterestDO May 8, 2025 100%
Corporate DirectorMedical Director May 8, 2025
Operational/Managerial ControlMedical Director May 8, 2025
Jared Clifford Individual Corporate OfficerPresident May 8, 2025
W-2 Managing EmployeeAd; May 8, 2025
Sheri N Davis Individual W-2 Managing EmployeeVP Provider Management May 8, 2025
Monya York Individual Corporate DirectorDirector Credentialing Jul 17, 2017
W-2 Managing EmployeeDirector Credentialing Jul 17, 2017
Operational/Managerial ControlDirector Credentialing Jul 17, 2017
Randi L Davis Individual W-2 Managing EmployeeDirector Provider Mgmnt May 8, 2025
Candice M Cartwright Individual W-2 Managing EmployeeVP of Operations May 8, 2025

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 6

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": "1734307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755734400000",
    "number": "1669289310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4196 HIGHWAY 62 412 STE A",
            "city": "HARDY",
            "state": "AR",
            "postal_code": "725428002",
            "telephone_number": "870-856-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 S COUNTRY CLUB RD",
            "city": "EL RENO",
            "state": "OK",
            "postal_code": "730365801",
            "telephone_number": "405-276-3800",
            "fax_number": "405-276-3912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY BIBB MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-16",
        "last_updated": "2025-08-21",
        "certification_date": "2025-08-21",
        "status": "A",
        "authorized_official_last_name": "YORK",
        "authorized_official_first_name": "MONYA",
        "authorized_official_title_or_position": "DIRECTOR CREDENTIALING",
        "authorized_official_telephone_number": "870-856-1202"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Access Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in El Reno, OK

Sources for this page

Verify at the official NPI Registry.