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

Last updated

Jan 23, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Karlee Campbell Bradberry Former name

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

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, LLCGroup PAC ID 0042513558, 47 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Oklahoma Cancer Specialists and Research Institute LLC

  • MOHS-Micrographic Surgery Physician
  • Broken Arrow, OK
  • NPI 1104291236
  Medicare reassignment Care Compare group
• Omni Medical Group Inc

  • Internal Medicine Physician
  • Tulsa, OK
  • NPI 1174578249
  Medicare reassignment
• St. John Physicians, Inc.

  • Internal Medicine Physician
  • Tulsa, OK
  • NPI 1336194406
  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

  dba Siggins Memorial Clinic

  • 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)

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

{
    "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

• Physician Assistant in Bentonville, AR
• Providers in Bentonville, AR by specialty
• 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.