NPIMap

Individual provider Active NPI

Nicholette Brosseau

  • Urgent Care Clinic/Center
  • Wagoner, OK
National Provider Identifier
1720639263
Registry record updated Nov 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Practice address
1520 SW 1St St
Wagoner, OK 74467-4839
Phone
(918) 704-7825
NPI assigned
Sep 25, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 9, 2020

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
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

1520 SW 1St St
Wagoner, OK 74467-4839

Mailing address

5130 S Hudson PL
Tulsa, OK 74135-7509
Phone (918) 704-7825

Other practice location 1

5130 S Hudson Pl
Tulsa, OK 74135-7509
Phone (918) 704-7825

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210922003205 OK Practitioner - Physician Assistant 0547667230 Reassigns benefits to 1 organization
I20220630000094 TX Practitioner - Physician Assistant 0547667230 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Creek Nation Hospital and Clinics 364 clinicians

Practice addresses (Care Compare)

1101 S Belmont Ave
Okmulgee, OK 74447-6315

1313 E 20TH St
Okmulgee Indian Health Center
Okmulgee, OK 74447-6303
Phone (918) 591-5700

Hospital & facility affiliations

  • Muscogee (Creek) Nation Medical Center Hospital, Okmulgee, OK, CCN 370057

Merit-based Incentive Payment System (MIPS)

Final score
85.12 of 100Reported as group
Quality
83.76
Promoting interoperability
100
Improvement activities
40
Cost
56.64

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Creek Nation Hospital & Clinics CurrentSince Jun 27, 2022 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Jun 27, 2022 Accepting new patients

Locations

1125 E Cleveland Ave
Sapulpa, OK 74066
Phone (918) 224-9310

Dept 1467
Tulsa, OK 74182

10109 E 79th St
Tulsa, OK 74133
Phone (888) 552-6760

Interoperability endpoints

  • Direct secure messaging: nbrosseau21721@muscogeecreeknation.direct-ci.com

Organizations & group practices 18

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.

View all 18

Hospital & facility affiliations 2

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": "1569369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604880000000",
    "number": "1720639263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5130 S HUDSON PL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741357509",
            "telephone_number": "918-704-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 SW 1ST ST",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744674839",
            "telephone_number": "918-704-7825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5130 S Hudson Pl",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741357509",
            "country_code": "US",
            "telephone_number": "918-704-7825",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROSSEAU",
        "first_name": "NICHOLETTE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-25",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wagoner, OK

Sources for this page

Verify at the official NPI Registry.