NPIMap

Individual provider Active NPI

Larry D. McKenzie, DO

  • Interventional Pain Medicine Physician
  • Broken Arrow, OK
National Provider Identifier
1003875212
Registry record updated Jul 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
3116 Issued in OK
Practice address
4716 W Urbana St Ste 200
Broken Arrow, OK 74012-6162
Phone
(918) 710-4112
Fax
(918) 710-4118
NPI assigned
Mar 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X 3116 OK
Family Medicine Physician 207Q00000X 3116 OK
Interventional Pain Medicine Physician 208VP0014X 3116 OK Primary

Addresses

Primary practice location

4716 W Urbana St Ste 200
Broken Arrow, OK 74012-6162

Mailing address

4716 W Urbana St Ste 200
Broken Arrow, OK 74012-6162
Phone (918) 710-4112

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060901000299 OK Practitioner - Pain ManagementPractitioner - Family Practice 5395749402 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain Management
Education
Oklahoma State University College of Osteopathic Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Access Pain SolutionsGroup PAC ID 2668620220, 13 clinicians

Practice addresses (Care Compare)

3401 W Broadway St
Muskogee, OK 74401-2136
Phone (918) 710-4112

3905 S Hwy 97
Sand Springs, OK 74063-6670
Phone (918) 710-4112

4750 S Garnett Rd
Tulsa, OK 74146-5222
Phone (918) 710-4112

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
21.53 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
71.76

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Access Pain Solutions CurrentSince Jun 1, 2021 Accepting new patients
The Camellia Foundation Family Medicine PastSince Sep 7, 2011 Accepting new patients
Medicos General PLLC Family Medicine PastSince Aug 4, 2010 Accepting new patients

Locations

4716 W Urbana St
Ste 200
Broken Arrow, OK 74012
Phone (918) 948-6360

3905 S State Highway 97
Ste A
Sand Springs, OK 74063

3905 S Highway 97
Sand Springs, OK 74063
Phone (918) 245-7500

7901 S Sheridan Rd
Tulsa, OK 74133

4750 S Garnett Rd
Tulsa, OK 74146
Phone (539) 812-2100

Organizations & group practices 3

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 10

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": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625529600000",
    "number": "1003875212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4716 W URBANA ST STE 200",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740126162",
            "telephone_number": "918-710-4112",
            "fax_number": "918-710-4118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4716 W URBANA ST STE 200",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740126162",
            "telephone_number": "918-710-4112",
            "fax_number": "918-710-4118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "LARRY",
        "middle_name": "D.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "OK",
            "license": "3116",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "3116",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "OK",
            "license": "3116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

Verify at the official NPI Registry.