NPIMap

Individual provider Active NPI

Dustin Wade

  • Family Nurse Practitioner
  • Shawnee, OK
National Provider Identifier
1013323336
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
91102 Issued in OK
Practice address
2508 N Harrison St
Shawnee, OK 74804-3131
Phone
(405) 585-2030
NPI assigned
Jul 8, 2014
Last updated
Jun 13, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 91102 OK Primary

Addresses

Primary practice location

2508 N Harrison St
Shawnee, OK 74804-3131

Mailing address

821 E Veterans Memorial Hwy
Blanchard, OK 73010-9215

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
I20190109002012 OK Practitioner - Nurse Practitioner 2668718891 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prague Healthcare AuthorityGroup PAC ID 8123435187, shared by 4 NPIs, 12 clinicians
Crossroads Medical Management LLCGroup PAC ID 4183856784, 5 clinicians
Advance Physicians GroupGroup PAC ID 0244122083, 23 clinicians

Practice addresses (Care Compare)

1322 Klabzuba Ave
Prague, OK 74864-4900
Phone (405) 567-4922

2508 N Harrison St
Shawnee, OK 74804-3131
Phone (405) 585-2030

7807 S Walker Ave
Oklahoma City, OK 73139-9470
Phone (405) 636-0767

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
91102OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Norman Regional Hospital Authority CurrentSince Jul 31, 2019 Accepting new patients
Advance Physicians Group CurrentSince Feb 19, 2024 Accepting new patients
Prague Healthcare Authority CurrentSince Sep 1, 2024 Accepting new patients
Crossroads Medical Management LLC CurrentSince Jun 1, 2023 Accepting new patients
Prague Healthcare Authority CurrentSince Sep 1, 2024 Accepting new patients
Icare Center LLC CurrentSince May 1, 2020 Accepting new patients
Norman Regional Hospital Authority CurrentSince Jul 31, 2019 Accepting new patients
St Anthony Shawnee Hospital Inc Past Accepting new patients
Allergy & Respiratory Clinic of Southern Ok LLC Past Accepting new patients

Locations

700 S Telephone Rd
Moore, OK 73160
Phone (405) 793-9355

3103 Azalea Park Dr
Muskogee, OK 74401
Phone (405) 759-4300

11521 S Western Ave
Ste B
Oklahoma City, OK 73170
Phone (405) 676-9125

2903 W Britton Rd
Oklahoma City, OK 73120
Phone (405) 755-8028

4510 NW 39th St
Oklahoma City, OK 73122
Phone (405) 495-5841

7807 S Walker Ave
Oklahoma City, OK 73139
Phone (405) 636-0767

1322 Klabzuba Ave
Prague, OK 74864
Phone (405) 567-2295

2508 N Harrison St
Shawnee, OK 74804
Phone (405) 395-5836

4010 N Kickapoo Ave
Ste 3
Shawnee, OK 74804
Phone (405) 759-4300

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/praguer-24b19aa5
  • FHIR API: https://fhir4.healow.com/fhir/r4/FIIACD/Endpoint/FIIACD

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1404777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1013323336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 E VETERANS MEMORIAL HWY",
            "city": "BLANCHARD",
            "state": "OK",
            "postal_code": "730109215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 N HARRISON ST",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748043131",
            "telephone_number": "405-585-2030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "DUSTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-08",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "91102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawnee, OK

Sources for this page

Verify at the official NPI Registry.