Individual provider Active NPI

Dawn Annette Buffington

  • Family Nurse Practitioner
  • Broken Arrow, OK
National Provider Identifier
1003532300
Registry record updated Jul 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
210689 Issued in OK
Practice address
1095 N Aspen Ave
Broken Arrow, OK 74012-9641
Phone
(918) 727-2870
NPI assigned
Oct 18, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X R0089376 OK
Family Nurse Practitioner 363LF0000X 210689 OK Primary

Addresses

Primary practice location

1095 N Aspen Ave
Broken Arrow, OK 74012-9641

Mailing address

12902 E 51St St Ste 3
Tulsa, OK 74134-6712
Phone (918) 994-3476

Other names 1

  • Dawn Annette Cockrum Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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 1

Enrollment IDStateProvider typePAC IDDetails
I20230915000582 OK Practitioner - Nurse Practitioner 0345604948 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Omni Medical Group IncGroup PAC ID 9739080490, 82 clinicians

Practice addresses (Care Compare)

8115 S Memorial Dr
Tulsa, OK 74133-4331
Phone (918) 254-6315

Hospital & facility affiliations

  • Ascension St John Medical Center Hospital, Tulsa, OK, CCN 370114
  • Ascension St John Broken Arrow Hospital, Broken Arrow, OK, CCN 370235

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R0089376OKMDRegistered Nurse
210689OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Omni Medical Group Inc CurrentSince Nov 18, 2023 Accepting new patients

Locations

1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345

8115 S Memorial Dr
Tulsa, OK 74133
Phone (918) 254-6315

Organizations & group practices 1

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1666051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690416000000",
    "number": "1003532300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12902 E 51ST ST STE 3",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741346712",
            "telephone_number": "918-994-3476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 N ASPEN AVE",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740129641",
            "telephone_number": "918-727-2870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUFFINGTON",
        "first_name": "DAWN",
        "middle_name": "ANNETTE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-18",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OK",
            "license": "R0089376",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "210689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAWN",
            "last_name": "COCKRUM",
            "middle_name": "ANNETTE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Broken Arrow, OK

Sources for this page

Verify at the official NPI Registry.