Dr Mary L Bradley-leboeuf, MD is a medicare enrolled "Pediatrics" physician in Idabel, Oklahoma. Her current practice location is
1307 Lynn Ln, Idabel, Oklahoma. You can reach out to her office (for appointments etc.) via phone at
(580) 286-5437.
Dr Mary L Bradley-leboeuf is licensed to practice in Oklahoma (license number 22507) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1497724041.
Physician's Profile
| Full Name | Dr Mary L Bradley-leboeuf |
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| Gender | Female |
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| Speciality | Pediatrics |
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| Location | 1307 Lynn Ln, Idabel, Oklahoma |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1497724041
- Provider Enumeration Date: 03/16/2006
- Last Update Date: 02/02/2011
Medicare PECOS Information:
- PECOS PAC ID: 0749475002
- Enrollment ID: I20101111001239
Medical Identifiers
Medical identifiers for Dr Mary L Bradley-leboeuf such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1497724041 | NPI | - | NPPES |
| 100187600B | Medicaid | OK | |
| 22507 | Other | OK | STATE MED LICENSE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208000000X | Pediatrics | 22507 (Oklahoma) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Mary L Bradley-leboeuf allows following entities to bill medicare on her behalf.
| Entity Name | Idabel Children's Clinic, Inc. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1689985343
PECOS PAC ID: 5890980155
Enrollment ID: O20101111001156 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Mary L Bradley-leboeuf is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Mary L Bradley-leboeuf, MD
1307 Lynn Ln,
Idabel, OK 74745-6845
Ph: (580) 286-5437 | Dr Mary L Bradley-leboeuf, MD
1307 Lynn Ln,
Idabel, OK 74745-6845
Ph: (580) 286-5437 |
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