Active NPI
Douglas John Ivins, MD
- Family Medicine Physician
- Tulsa, OK
National Provider Identifier
1023080090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 23164
- Practice address
- 1111 S St Louis Ave
Tulsa, OK 74120 - Phone
- (918) 619-4600
- Fax
- (918) 619-4601
- NPI assigned
- Feb 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 23164 | OK | Primary |
Addresses
Primary practice location
1111 S St Louis Ave
Tulsa, OK 74120
Mailing address
PO Box 268838
Oklahoma City, OK 73126-8838
Phone (918) 660-3632
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20001760C | Medicaid | OK |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241114000848 | OK | Order and Referring Only - Family Practice | 3375449267 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23164 | OK | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1023080090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 268838",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731268838",
"telephone_number": "918-660-3632",
"fax_number": "918-660-3631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 S ST LOUIS AVE",
"city": "TULSA",
"state": "OK",
"postal_code": "74120",
"telephone_number": "918-619-4600",
"fax_number": "918-619-4601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVINS",
"first_name": "DOUGLAS",
"middle_name": "JOHN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-03",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "23164",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "20001760C",
"state": "OK"
}
],
"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 Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.