Karlee Campbell Van Dam, PA-S

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA1099 Issued in AR

Practice address

901 SE 22ND St
Bentonville, AR 72712-4196

Phone

(479) 273-7006

Fax

(479) 273-9497

NPI assigned

Sep 28, 2019

Sex

Female

Sole proprietor

No

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.

• Oklahoma Cancer Specialists and Research Institute LLC

  • MOHS-Micrographic Surgery Physician
  • Broken Arrow, OK
  • NPI 1104291236

  OK

  Medicare reassignment Care Compare group
• St. John Physicians, Inc.

  • Internal Medicine Physician
  • Tulsa, OK
  • NPI 1336194406

  OK

  Medicare reassignment NPD (past)
• Omni Medical Group Inc

  • Internal Medicine Physician
  • Tulsa, OK
  • NPI 1174578249

  OK

  Medicare reassignment
• Oklahoma Cancer Specialists and Research Institute LLC

  • Hematology & Oncology Physician
  • Stillwater, OK
  • NPI 1932574068
  NPD
• Oklahoma Cancer Specialists and Research Institute, LLC

  • Surgical Oncology Physician
  • Tulsa, OK
  • NPI 1194396721
  NPD
• St. John Physicians, Inc

  • Rural Health Clinic/Center
  • Barnsdall, OK
  • NPI 1033176367
  NPD
• Tulsa Cancer Institute PLLC

  • Hematology & Oncology Physician
  • Tulsa, OK
  • NPI 1508172982
  NPD
• Ameripath SC Inc

  • Clinical Medical Laboratory
  • Mount Pleasant, SC
  • NPI 1528030368
  NPD (past)
• Oklahoma Cancer Specialists and Research Institute LLC

  • Hematology & Oncology Physician
  • Tulsa, OK
  • NPI 1962876045
  NPD (past)

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oklahoma Cancer Specialists and Research Institute, LLC 47 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in OK, AR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

• Karlee Campbell Bradberry Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 23, 2023.

{
    "created_epoch": "1569628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674432000000",
    "number": "1972154185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4375 N VANTAGE DR STE 305",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034984",
            "telephone_number": "479-335-1831",
            "fax_number": "479-249-6958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 SE 22ND ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727124196",
            "telephone_number": "479-273-7006",
            "fax_number": "479-273-9497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DAM",
        "first_name": "KARLEE",
        "middle_name": "CAMPBELL",
        "credential": "PA-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-28",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "3137",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA1099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KARLEE",
            "last_name": "BRADBERRY",
            "middle_name": "CAMPBELL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jaime Valdes, PT
• Kimberly L Valdez, LCSW
• Stephnie V Valek I
• Rafael T Valentin Jr., LAC (LICENSED COUNSE
• Yosielin Valle
• Dylan Blake Vandever, LPC
• Long Vang, MHPP
• Yue Pheng Vang, PHARMD
• Udaya Vanga
• Caitlin Danielle Vanginhoven, DPT

• All providers in Bentonville, AR
• Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.