Individual provider Active NPI

Charles C Powell, MD

  • Family Medicine Physician
  • Tulsa, OK
National Provider Identifier
1003887936
Registry record updated Jul 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
23749 Issued in OK
Practice address
7501 Riverside Pkwy
Tulsa, OK 74136
Phone
(918) 710-4200
Fax
(918) 403-6331
NPI assigned
Jan 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 23749 OK Primary

Addresses

Primary practice location

7501 Riverside Pkwy
Tulsa, OK 74136

Mailing address

7501 Riverside Pkwy
Tulsa, OK 74136-5056
Phone (918) 710-4200

Other identifiers 1

IdentifierTypeStateIssuer
200021790AMedicaidOK

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040301001037 OK Practitioner - Family Practice 7618864000 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc. Family Medicine CurrentSince Jul 1, 2011 Accepting new patients
St. John Physicians, Inc CurrentSince Jul 1, 2011 Accepting new patients
St John Urgent Care Clinics Inc Past Accepting new patients

Locations

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

7501 Riverside Pkwy
Tulsa, OK 74136
Phone (918) 710-4200

1705 E 19th St
Ste 304
Tulsa, OK 74104
Phone (918) 748-7660

Interoperability endpoints

  • Direct secure messaging: charles.powell@direct.stjohnhealthsystem.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531267200000",
    "number": "1003887936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7501 RIVERSIDE PKWY",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741365056",
            "telephone_number": "918-710-4200",
            "fax_number": "918-403-6331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7501 RIVERSIDE PKWY",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74136",
            "telephone_number": "918-710-4200",
            "fax_number": "918-403-6331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWELL",
        "first_name": "CHARLES",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2018-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "23749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200021790A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.