NPIMap

Individual provider Active NPI

Brady Jay Coburn, MD

  • Plastic Surgery Physician
  • Maywood, IL
National Provider Identifier
1811491202
Registry record updated Jun 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
125.072863 Issued in IL
Practice address
2160 S 1St Ave
Maywood, IL 60153
Phone
(708) 327-3041
NPI assigned
Mar 20, 2018
Last updated
Jun 6, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2018

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 IL
Plastic Surgery Physician 208200000X 125.072863 IL Primary

Addresses

Primary practice location

2160 S 1St Ave
Maywood, IL 60153

Mailing address

2160 S 1St Ave
Maywood, IL 60153-3328
Phone (708) 327-3041

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
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
I20240719003539 SD Practitioner - Plastic and Reconstructive Surgery 0749538288 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Sanford School of Medicine of University of South Dakota, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Plastic Surgery Associates of South Dakota, LTDGroup PAC ID 0446289540, 4 clinicians

Practice addresses (Care Compare)

4201 S Minnesota Ave
Suite 112
Sioux Falls, SD 57105-6706
Phone (605) 335-3349

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.072863ILMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Upper Midwest Medical Inc CurrentSince Aug 5, 2024 Accepting new patients
Loyola University Medical Center Current Accepting new patients
Plastic Surgery Associates of South Dakota, LTD Plastic Surgery CurrentSince Aug 5, 2024 Accepting new patients
Rivers Edge Aesthetic Surgery, LLC Past Accepting new patients

Locations

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

319 Dakota Dunes Blvd
Ste B
North Sioux City, SD 57049
Phone (605) 232-9720

4201 S Minnesota Ave
Ste 112
Sioux Falls, SD 57105
Phone (602) 232-9720

401 9th Ave NW
Watertown, SD 57201
Phone (605) 886-9317

Interoperability endpoints

  • Direct secure messaging: bcoburn93156@direct.luhs.org

Organizations & group practices 4

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 24

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1521504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528243200000",
    "number": "1811491202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-327-3041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-327-3041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COBURN",
        "first_name": "BRADY",
        "middle_name": "JAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-20",
        "last_updated": "2018-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "IL",
            "license": "125.072863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.