Individual provider Active NPI

Hayden Mackenzie Bryan, MD

  • Surgery Physician
  • Oklahoma City, OK
National Provider Identifier
1710588694
Registry record updated May 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
39652 Issued in OK
Practice address
800 Stanton L Young Blvd # 9432
Oklahoma City, OK 73104-5018
Phone
(405) 271-6308
NPI assigned
Nov 5, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Surgery Physician 208600000X 39652 OK Primary

Addresses

Primary practice location

800 Stanton L Young Blvd # 9432
Oklahoma City, OK 73104-5018

Mailing address

800 Stanton L Young Blvd
Oklahoma City, OK 73104-5018

Other practice location 1

1211 Medical Center Dr
Nashville, TN 37232-3433
Phone (615) 322-5000

Other practice location 2

1161 21st Avenue South
CCC-4322 MCN
Nashville, TN 37232
Phone (615) 343-6642

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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

Enrollment IDStateProvider typePAC IDDetails
I20260610000798 LA Order and Referring Only - Colorectal Surgery (Proctology)Practitioner - Colorectal Surgery (Proctology) 1456822493

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39652OKMDSurgery Physician

NPI Registry JSON

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

{
    "created_epoch": "1604534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652659200000",
    "number": "1710588694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 STANTON L YOUNG BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 STANTON L YOUNG BLVD # 9432",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045018",
            "telephone_number": "405-271-6308"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1211 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372323433",
            "country_code": "US",
            "telephone_number": "615-322-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1161 21st Avenue South",
            "address_2": "CCC-4322 MCN",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "37232",
            "country_code": "US",
            "telephone_number": "615-343-6642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "HAYDEN",
        "middle_name": "MACKENZIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-05",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OK",
            "license": "39652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.