Individual provider Active NPI

Clinton Alsup

  • Certified Registered Nurse Anesthetist
  • Tulsa, OK
National Provider Identifier
1013451939
Registry record updated Dec 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
117129 Issued in OK
Practice address
1120 S Utica Ave
Tulsa, OK 74104-4012
Phone
(800) 939-7440
NPI assigned
Dec 12, 2016
Last updated
Dec 12, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 117129 OK Primary

Addresses

Primary practice location

1120 S Utica Ave
Tulsa, OK 74104-4012

Mailing address

10937 S Elgin Ave
Jenks, OK 74037-2643

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170217001317 OK Practitioner - Certified Registered Nurse Anesthetist (Crna) 7911280904 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Anesthesiologists, Inc.Group PAC ID 7911989017, 111 clinicians

Practice addresses (Care Compare)

6839 S Canton Ave
Tulsa, OK 74136-3402
Phone (918) 494-0612

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
117129OKMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Emergenchealth PLLC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2019 Accepting new patients
Integral Anesthesia, LLC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2025 Accepting new patients

Locations

1202 N Muskogee Pl
Claremore, OK 74017
Phone (918) 341-2556

3029 W Main St
Jenks, OK 74037
Phone (918) 346-5002

10512 N 110th East Ave
Owasso, OK 74055
Phone (918) 272-1172

1120 S Utica Ave
Tulsa, OK 74104
Phone (918) 579-6090

Organizations & group practices 4

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": "1481500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481500800000",
    "number": "1013451939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10937 S ELGIN AVE",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740372643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 S UTICA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044012",
            "telephone_number": "800-939-7440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALSUP",
        "first_name": "CLINTON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-12-12",
        "last_updated": "2016-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OK",
            "license": "117129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.