JACK BRADLEY SMITH (PA) – Physician Assistant, NPI 1528036704

JACK BRADLEY SMITH (PA) is a healthcare provider. based in Oklahoma city, Oklahoma. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA. They hold a License No. 1155 (OK). The NPI Number for JACK BRADLEY SMITH (PA) is 1528036704

Main info

Male
25 Years Of Experience
Accepts Medicare Assignment
Name
JACK BRADLEY SMITH (PA)
NPI
1528036704
Phone
(405) 815-5600
Address
3400 S Douglas Blvd
Enumeration Date
14 March 2006
Last Update Date
1 December 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9187204957
Graduation Year
2001 (25 years ago)
PAC ID
2466344510
Group Practice PAC ID
2769877000
Professional Enrollment ID
I20040325000815
Address ID
OK731166494NI6440XDRXX302
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience64
Completeness85
Years active:20State licenses:1Digital endpointsOther names

1,797 PHYSICIAN ASSISTANT in OK

Provider Addresses for JACK BRADLEY SMITH (PA)

  • 3400 S Douglas Blvd

    Oklahoma City, OK 731501001

    Phone: (405) 815-5600

    Type: Location

  • 13401 N Western Ave

    Oklahoma City, OK 731141408

    Phone: (405) 252-3400

    Type: Location

  • 5200 E I 240 Service Rd

    Oklahoma City, OK 731352607

    Phone: (405) 628-6000

    Type: Location

  • 700 NE 13th St

    Oklahoma City, OK 731045004

    Phone: (405) 271-5321

    Type: Location

  • 4050 W Memorial Rd

    Oklahoma City, OK 731208382

    Phone: (405) 608-3800

    Type: Location

  • 13500 S Tulsa Dr

    Oklahoma City, OK 731709719

    Phone: (405) 815-5600

    Type: Location

  • 201 S Sara Rd

    Mustang, OK 730644306

    Phone: (405) 376-4505

    Type: Location

  • 2115 Parkview Drive

    El Reno, OK 730360000

    Phone: (405) 262-2640

    Type: Location

  • 1000 N Lee Ave

    Oklahoma City, OK 731021036

    Phone: (405) 272-7000

    Type: Location

  • West Memorial Road, Oklahoma City, Oklahoma County, Oklahoma, 73142, United States

    OKLAHOMA CITY, OK 731341785

    Phone: (405) 751-4664

    Fax: (405) 749-4561

    Type: Location

  • 18432 WILD HORSE TRL

    NORMAN, OK 730729603

    Phone: (405) 760-0560

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2004-03-25

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20040325000815IPhysician AssistantOKTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99285Emergency department visit with high level of medical decision making6664$0
99284Emergency department visit with moderate level of medical decision making4948$0
View full utilization report →

Insurance plans in this area (ZIP 73150)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2769877000View full group profile
NameSpecialtyState
Nurse PractitionerMO
Nurse PractitionerOK
Physician AssistantUT
General Practice, Family PracticeOK
Nurse PractitionerMO

Reviews

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Frequently asked questions

What federal number belongs to JACK BRADLEY SMITH (PA)?
The federal identifier for JACK BRADLEY SMITH (PA) is NPI 1528036704.
Does this profile mean JACK BRADLEY SMITH (PA) is currently active?
Yes — JACK BRADLEY SMITH (PA) appears active in the national provider directory.
What does JACK BRADLEY SMITH (PA) treat or focus on?
Patients typically see JACK BRADLEY SMITH (PA) under the specialty Physician Assistant. Clinical services aligned with this taxonomy classification.
What location metadata exists for JACK BRADLEY SMITH (PA)?
The page summarizes Oklahoma City, Oklahoma for JACK BRADLEY SMITH (PA); expand the address list for detail.
Is JACK BRADLEY SMITH (PA) a real provider?
This page reflects official NPPES data for NPI 1528036704. Always confirm identity and privileges with the practice and licensing boards.

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