Individual provider Active NPI

Pooja Dipak Rao, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Tulsa, OK
National Provider Identifier
1013352376
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
41922 Issued in OK
Practice address
4720 S Harvard Ave Ste 100
Tulsa, OK 74135-3023
Phone
(918) 403-4120
Fax
(918) 856-5058
NPI assigned
Apr 30, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 192229 NC
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 0116028928 VA
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 2020-04462 NC
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 41922 OK Primary

Addresses

Primary practice location

4720 S Harvard Ave Ste 100
Tulsa, OK 74135-3023

Mailing address

10210 S College Ave
Tulsa, OK 74137-8715
Phone (201) 786-8189

Other practice location 1

1923 S Utica Ave Fl 4
Tulsa, OK 74104-6520
Phone (918) 748-7650

Other practice location 2

Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2255

Other practice location 3

4100 New Hermitage Dr
Henrico, VA 23228
Phone (012) 786-8189

Other identifiers 1

IdentifierTypeStateIssuer
1013352376OtherVANPI

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
I20231115000014 OK Practitioner - Endocrinology 0345481222 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St. John Physicians, Inc.Group PAC ID 2567366495, 262 clinicians

Practice addresses (Care Compare)

1923 S Utica Ave
Tulsa, OK 74104-6520
Phone (918) 744-2071

Hospital & facility affiliations

  • Ascension St John Medical Center Hospital, Tulsa, OK, CCN 370114
  • Ascension St John Jane Phillips Hospital, Bartlesville, OK, CCN 370018
  • St John Owasso Hospital, Owasso, OK, CCN 370227
  • Ascension St John Broken Arrow Hospital, Broken Arrow, OK, CCN 370235
  • Ascension St John Sapulpa Hospital, Sapulpa, OK, CCN 371312

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
192229NCMDInternal Medicine Physician
41922OKMDEndocrinology, Diabetes & Metabolism Physician
0116028928VAMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc. Internal Medicine CurrentSince Jul 1, 2023 Accepting new patients
St. John Physicians, Inc CurrentSince Sep 18, 2023 Accepting new patients
Jane Phillips Memorial Medical Center, Inc. Past Accepting new patients

Locations

1923 S Utica Ave
Fl 4
Tulsa, OK 74104
Phone (918) 748-7650

4720 S Harvard Ave
Ste 100
Tulsa, OK 74135
Phone (918) 749-6730

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

1923 S Utica Ave
Lowr
Tulsa, OK 74104
Phone (918) 744-2071

2000 S Wheeling Ave
Ste 100
Tulsa, OK 74104
Phone (918) 403-7070

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

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 7

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": "1367280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1013352376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10210 S COLLEGE AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741378715",
            "telephone_number": "201-786-8189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4720 S HARVARD AVE STE 100",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741353023",
            "telephone_number": "918-403-4120",
            "fax_number": "918-856-5058"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1923 S Utica Ave Fl 4",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741046520",
            "country_code": "US",
            "telephone_number": "918-748-7650",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Medical Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271570001",
            "country_code": "US",
            "telephone_number": "336-716-2255",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4100 New Hermitage Dr",
            "address_purpose": "LOCATION",
            "city": "Henrico",
            "state": "VA",
            "postal_code": "23228",
            "country_code": "US",
            "telephone_number": "012-786-8189",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAO",
        "first_name": "POOJA",
        "middle_name": "DIPAK",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-30",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "192229",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "VA",
            "license": "0116028928",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NC",
            "license": "2020-04462",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "OK",
            "license": "41922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1013352376",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.