Organization Active NPI

Bruce a Mackey MD PC

  • Pain Medicine Physician
  • Edmond, OK
National Provider Identifier
1770787418
Registry record updated Sep 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
16205 Issued in OK
Legal business name
BRUCE A MACKEY MD PC
Practice address
3957 E Covell Rd
Edmond, OK 73034-6909
Phone
(405) 285-7246
Fax
(405) 285-7546
NPI assigned
Jun 14, 2007
Last updated
Sep 19, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2013

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

Authorized official

Name
Bruce A Mackey, MDNPI 1891799821
Title
President
Phone
(405) 285-7246

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine Physician 208VP0000X 16205 OK Primary

Addresses

Primary practice location

3957 E Covell Rd
Edmond, OK 73034-6909

Mailing address

3957 E Covell Rd
Edmond, OK 73034-6909
Phone (405) 285-7246

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070815000485 OK Part B Supplier - Clinic/Group Practice 5395837736 Receives reassigned benefits from 4 practitioners
Practice locations: Edmond, OK

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D2036264Bruce a Mackey, MD PC3957 E Covell Rd, Edmond, OK 73034AccreditationSep 30, 2026
37D2317417Bruce a Mackey MD PC3957 E Covell Rd, Edmond, OK 73034Certificate of waiverJan 22, 2027

National Provider Directory

National Provider Directory

Locations

3957 E Covell Rd
Edmond, OK 73034
Phone (405) 285-7246

841 S Kelly Ave
Ste 110
Edmond, OK 73003
Phone (405) 285-7246

Practitioners & affiliated clinicians

Practitioners 7

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": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379548800000",
    "number": "1770787418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3957 E COVELL RD",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730346909",
            "telephone_number": "405-285-7246",
            "fax_number": "405-285-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3957 E COVELL RD",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730346909",
            "telephone_number": "405-285-7246",
            "fax_number": "405-285-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE A MACKEY MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2013-09-19",
        "status": "A",
        "authorized_official_last_name": "MACKEY",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-285-7246",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "OK",
            "license": "16205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.