NPIMap

Individual provider Active NPI

Bretton Howard Breazeale, MD

  • Vascular & Interventional Radiology Physician
  • Klamath Falls, OR
National Provider Identifier
1699883785
Registry record updated Jun 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
MD26555 Issued in OR
Practice address
2900 Daggett Ave
Klamath Falls, OR 97601
Phone
(541) 205-3974
Fax
(541) 205-5652
NPI assigned
Aug 28, 2006
Last updated
Jun 23, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD26555 OR
Vascular & Interventional Radiology Physician 2085R0204X MD26555 OR Primary

Addresses

Primary practice location

2900 Daggett Ave
Klamath Falls, OR 97601

Mailing address

PO Box 7326
Klamath Falls, OR 97602-0326
Phone (541) 205-3974

Other identifiers 2

IdentifierTypeStateIssuer
213057MedicaidOR
XPY204768MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070117000534 OR Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 9537160544 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
Loma Linda University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sky Lakes Medical Center IncGroup PAC ID 1052204096, 196 clinicians

Practice addresses (Care Compare)

2821 Daggett Ave
Suite 100
Klamath Falls, OR 97601-1106
Phone (541) 274-6733

2865 Daggett Ave
Klamath Falls, OR 97601-1106
Phone (541) 274-6221

2900 Daggett Ave
Klamath Falls, OR 97601-7101
Phone (541) 884-1371

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Sky Lakes Medical Center Inc CurrentSince Jan 1, 2013 Accepting new patients
Last Frontier Healthcare District Diagnostic Radiology Current Accepting new patients
Sky Lakes Medical Center Inc CurrentSince Jan 1, 2013 Accepting new patients
Last Frontier Healthcare District Past Accepting new patients

Locations

1111 N Nagle St
Alturas, CA 96101
Phone (530) 708-8800

2865 Daggett Ave
Klamath Falls, OR 97601
Phone (541) 833-6221

2900 Daggett Ave
Klamath Falls, OR 97601
Phone (541) 884-1371

Organizations & group practices 4

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 4

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": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403481600000",
    "number": "1699883785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7326",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976020326",
            "telephone_number": "541-205-3974",
            "fax_number": "541-205-5652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 DAGGETT AVE",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "97601",
            "telephone_number": "541-205-3974",
            "fax_number": "541-205-5652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREAZEALE",
        "first_name": "BRETTON",
        "middle_name": "HOWARD",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-28",
        "last_updated": "2014-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD26555",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "OR",
            "license": "MD26555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213057",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XPY204768",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Klamath Falls, OR

Sources for this page

Verify at the official NPI Registry.