Individual provider Active NPI

Brandon Christopher Humble, MD

  • Student in an Organized Health Care Education/Training Program
  • Shreveport, LA
National Provider Identifier
1891158341
Registry record updated May 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1501 Kings Hwy
Internal Medicine
Shreveport, LA 71103-4228
Phone
(318) 813-2528
Fax
(318) 813-2525
NPI assigned
Apr 1, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1501 Kings Hwy
Internal Medicine
Shreveport, LA 71103-4228

Mailing address

1501 Kings Hwy
Internal Medicine
Shreveport, LA 71103-4228
Phone (318) 813-2528

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210608000565 OK Practitioner - Allergy/Immunology 8022304161 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/Immunology
Education
University of Oklahoma College of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allergy Clinic of Tulsa IncGroup PAC ID 7315925831, 12 clinicians

Practice addresses (Care Compare)

9311 S Mingo Rd
Tulsa, OK 74133-5702
Phone (918) 307-1613

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Allergy Clinic of Tulsa, Inc. CurrentSince May 20, 2021 Accepting new patients
Ahs Oklahoma Physician Group LLC PastSince May 20, 2021 Accepting new patients

Locations

9311 S Mingo Rd
Tulsa, OK 74133
Phone (918) 307-1613

1727 S Utica Ave
Tulsa, OK 74104
Phone (918) 307-1613

6802 S Olympia Ave
Ste 150
Tulsa, OK 74132
Phone (918) 307-1613

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FADFAD
  • FHIR API: https://epicproxy.ardenthealth.com/fhir/UPC/api/FHIR/R4

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1459468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462752000000",
    "number": "1891158341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "INTERNAL MEDICINE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-813-2528",
            "fax_number": "318-813-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "INTERNAL MEDICINE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-813-2528",
            "fax_number": "318-813-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMBLE",
        "first_name": "BRANDON",
        "middle_name": "CHRISTOPHER",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-01",
        "last_updated": "2016-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.