Individual provider Active NPI

Tiffany Gail Brazeal, M.D.

  • Dermatology Physician
  • Oklahoma City, OK
National Provider Identifier
1942239199
Registry record updated Oct 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
27705 Issued in OK
Practice address
9720 Broadway Ext
Oklahoma City, OK 73114-6315
Phone
(405) 280-7546
Fax
(405) 772-8674
NPI assigned
Jul 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 27705 OK Primary

Addresses

Primary practice location

9720 Broadway Ext
Oklahoma City, OK 73114-6315

Mailing address

PO Box 268986
Oklahoma City, OK 73126-8986
Phone (405) 231-3857

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
I20101111001416 OK Practitioner - Dermatology 8820182934 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Oklahoma College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saints Medical Group, LLCGroup PAC ID 7012914898, 430 clinicians

Practice addresses (Care Compare)

1440 N Mustang Rd
Mustang, OK 73064-7214
Phone (405) 280-7546

608 NW 9TH St
Oklahoma City, OK 73102-1049

Hospital & facility affiliations

  • SSM Health St Anthony Hospital - Oklahoma City Hospital, Oklahoma City, OK, CCN 370037

Merit-based Incentive Payment System (MIPS)

Final score
85.96 of 100Reported as group
Quality
80.43
Promoting interoperability
100
Improvement activities
40
Cost
72.76

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision17
Removal of skin lesions1297
Removal or shaving of skin growth17
Skin biopsy356

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care of Oklahoma, Inc. CurrentSince Jan 15, 2015 Accepting new patients
Saints Medical Group, LLC CurrentSince Sep 1, 2010 Accepting new patients
SSM Health Care of Oklahoma Inc CurrentSince Jan 15, 2015 Accepting new patients
Saints Medical Group, LLC Dermatology CurrentSince Sep 1, 2010 Accepting new patients
SSM Health Care of Oklahoma, Inc Current Accepting new patients
Summit Medical Center Past Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients

Locations

7106 Solutions Ctr
Chicago, IL 60677

1440 N Mustang Rd
Mustang, OK 73064
Phone (405) 280-7546

9720 Broadway Ext
Oklahoma City, OK 73114
Phone (405) 280-7546

608 NW 9th St
Ste 2200
Oklahoma City, OK 73102
Phone (405) 231-3737

608 NW 9th St
Ste 1100
Oklahoma City, OK 73102
Phone (405) 231-3000

Interoperability endpoints

  • Direct secure messaging: tbrazeal36948@direct-ehr-ssmhc.com

Organizations & group practices 7

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.

Hospital & facility affiliations 2

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": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413763200000",
    "number": "1942239199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268986",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731268986",
            "telephone_number": "405-231-3857",
            "fax_number": "405-272-7977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9720 BROADWAY EXT",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731146315",
            "telephone_number": "405-280-7546",
            "fax_number": "405-772-8674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAZEAL",
        "first_name": "TIFFANY",
        "middle_name": "GAIL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-01",
        "last_updated": "2014-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OK",
            "license": "27705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.