SHANNON BRUEY – Nurse Practitioner, NPI 1265985717
Nurse Practitioner
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SHANNON BRUEY
1202 W FARM RD
STILLWATER, OK 740782000
Phone: (405) 744-7665
Fax: (405) 744-6556
Type: Location
Edwin Fair Community Health Clinic, 1500, North 6th Street, Ponca City, Kay County, Oklahoma, 74601, United States
PONCA CITY, OK 746012827
Phone: (580) 763-6103
Fax: (580) 762-2576
Type: Mailing
Harbor Road, Oxford County, Maine, 04219, United States
GROVE, OK 743443505
Phone: (918) 786-4434
Fax: (918) 786-4435
Type: Location
121 W MAPLE AVE
ENID, OK 737014027
Phone: (580) 348-2978
Fax: (580) 348-2977
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $42.
Total Amount is formed as General ($42) + Research ($0) + Ownership ($0) = $42.
Last reported payment date: 2024-08-19 • Largest payer in this snapshot: ABBVIE INC. ($42).
Total Amount
$42
General + Research + Ownership
Payments
2
Total payment records
General Amount
$42
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-19
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $42 |
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: 2017-06-20
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20170620001731 | I | Nurse Practitioner | OK | TBD |
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.
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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 74078)
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