NPIMap

Individual provider Active NPI

Brady L Luttrell, M.D.

  • Family Medicine Physician
  • Brookline, MO
National Provider Identifier
1790814481
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2021047213 Issued in MO
Practice address
3203 E Old Stone Ave
Brookline, MO 65619-9620
Phone
(417) 269-1910
Fax
(417) 269-1916
NPI assigned
Mar 5, 2007
Last updated
Apr 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2021047213 MO Primary

Addresses

Primary practice location

3203 E Old Stone Ave
Brookline, MO 65619-9620

Mailing address

PO Box 505673
Saint Louis, MO 63150-5673
Phone (417) 730-6430

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20220211000283 MO Practitioner - Family Practice 4880784909 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kansas School of Med (KC/Wich/Sal), 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lester E Cox Medical CentersGroup PAC ID 5799787784, 240 clinicians

Practice addresses (Care Compare)

510 Hwy 32
Suite C
Lebanon, MO 65536-5303
Phone (417) 269-2278

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2021047213MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities Family Medicine CurrentSince Jan 31, 2022 Accepting new patients
Lester E Cox Medical Centers Family Medicine Current Accepting new patients
Lester E Cox Medical Centers Family Medicine CurrentSince Mar 18, 2024 Accepting new patients
Lester E Cox Medical Centers Family Medicine CurrentSince Mar 18, 2024 Accepting new patients
Lester E. Cox Medical Centers Past Accepting new patients
Lester E Cox Medical Centers Family Medicine PastSince Jul 21, 2024 Accepting new patients
Scott & White Memorial Hospital PastSince Oct 1, 2020 Accepting new patients
Lester E Cox Medical Centers PastSince Mar 13, 2022 Accepting new patients

Locations

3203 E Old Stone Ave
Brookline, MO 65619
Phone (417) 269-1910

510 Highway 32
Ste C
Lebanon, MO 65536
Phone (417) 269-2278

18598 Business 13
Reeds Spring, MO 65737
Phone (417) 272-1785

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

3801 S National Ave
Ste 1122
Springfield, MO 65807

Organizations & group practices 9

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": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1790814481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 505673",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631505673",
            "telephone_number": "417-730-6430",
            "fax_number": "417-269-7567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3203 E OLD STONE AVE",
            "city": "BROOKLINE",
            "state": "MO",
            "postal_code": "656199620",
            "telephone_number": "417-269-1910",
            "fax_number": "417-269-1916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUTTRELL",
        "first_name": "BRADY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-05",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2021047213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookline, MO

Sources for this page

Verify at the official NPI Registry.