Broken Arrow Diagnostic Medicine, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BROKEN ARROW DIAGNOSTIC MEDICINE, PLLC

Practice address

5050 E Kenosha St
Broken Arrow, OK 74014-6711

Phone

(918) 994-5140

Fax

(918) 994-5150

NPI assigned

May 6, 2013

Last updated

Oct 8, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jacob Leon Callison, PANPI 1487885877

Title

Managing Member

Phone

(918) 994-5140

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/7102/brand/2/csg/1/fhir/r4

Practitioners 3

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.

• Jacob Leon Callison, PA

  • Physician Assistant
  • Broken Arrow, OK
  • NPI 1487885877
  NPD Authorized official
• Robbie Michelle Bollinger, PA-C

  • Physician Assistant
  • Broken Arrow, OK
  • NPI 1457711038
  NPD (past)
• Robert L Valentine, MD

  • Family Medicine Physician
  • Broken Arrow, OK
  • NPI 1528388717
  NPD (past)

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

{
    "created_epoch": "1367798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1710322672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 E KENOSHA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740146711",
            "telephone_number": "918-994-5140",
            "fax_number": "918-994-5150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 E KENOSHA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740146711",
            "telephone_number": "918-994-5140",
            "fax_number": "918-994-5150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROKEN ARROW DIAGNOSTIC MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-06",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "CALLISON",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "LEON",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "918-994-5140",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephani Brooke Brisbin
• Merle Gene Brock, LMFT
• Broken Arrow Bone and Joint Specialists, PC
• Broken Arrow Counseling Services LLC
• Broken Arrow Dental and Implants, LLC
• Broken Arrow Endodontics
• Broken Arrow Family Clinic Inc
• Broken Arrow Family Dentistry PLLC
• Broken Arrow Family Practice Center
• Broken Arrow Family Practice Center PLC

• Family Medicine Physician in Broken Arrow, OK
• Providers in Broken Arrow, 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 Oct 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.