Active NPI
Brendan Dominic Oconnor, MD
- Diagnostic Radiology Physician
- Portland, TX
National Provider Identifier
1861457582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- J3864
- Practice address
- 115 Northshore Blvd
Portland, TX 78374 - Phone
- (361) 777-1777
- NPI assigned
- Apr 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | J3864 | TN | Primary |
Addresses
Primary practice location
115 Northshore Blvd
Portland, TX 78374
Mailing address
PO Box 1888
Greenville, TX 75403
Phone (800) 945-2455
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036852401 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J3864 | TN | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Portland Imaging Center, LTD | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Radiology Clinic/Center
- Portland, TX
- NPI 1740366707
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210723200000",
"number": "1861457582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1888",
"city": "GREENVILLE",
"state": "TX",
"postal_code": "75403",
"telephone_number": "800-945-2455",
"fax_number": "903-453-2541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 NORTHSHORE BLVD",
"city": "PORTLAND",
"state": "TX",
"postal_code": "78374",
"telephone_number": "361-777-1777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OCONNOR",
"first_name": "BRENDAN",
"middle_name": "DOMINIC",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-18",
"last_updated": "2008-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "TN",
"license": "J3864",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036852401",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.