Individual provider Active NPI

Marvin Dale Rodgers, D.O.

  • Family Medicine Physician
  • Oklahoma City, OK
National Provider Identifier
1023090610
Registry record updated Mar 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2192 Issued in OK
Practice address
210 SW 89TH St
Oklahoma City, OK 73139-8514
Phone
(405) 631-1116
Fax
(405) 631-1825
NPI assigned
Nov 18, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 2, 2010

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 2192 OK Primary

Addresses

Primary practice location

210 SW 89TH St
Oklahoma City, OK 73139-8514

Mailing address

210 SW 89TH St
Oklahoma City, OK 73139-8514
Phone (405) 631-1116

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
I20100721000046 OK Practitioner - Family Practice 6709918188 Practice locations: Oklahoma City, OK

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oklahoma State University College of Osteopathic Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

210 SW 89TH St
Oklahoma City, OK 73139-8532
Phone (405) 631-1116

Hospital & facility affiliations

  • Haven Home Health & Hospice Home health agency, Norman, OK, CCN 377794
  • Integris Southwest Medical Center Hospital, Oklahoma City, OK, CCN 370106
  • O U Medical Center Hospital, Oklahoma City, OK, CCN 370093
  • Oklahoma Center for Orthopaedic & Multi-SP Hospital, Oklahoma City, OK, CCN 370212
  • Norman Regional Hospital, Norman, OK, CCN 370008
  • Community Hospital, LLC Hospital, Oklahoma City, OK, CCN 370203

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions52
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2192OKMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ronald R. Hopkins, D.O., PLLC Family Medicine Current Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

210 SW 89th St
Oklahoma City, OK 73139
Phone (405) 631-0161

210 SW 89th St
Ste A
Oklahoma City, OK 73139
Phone (405) 631-0663

Organizations & group practices 2

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 8

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": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267488000000",
    "number": "1023090610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 SW 89TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731398514",
            "telephone_number": "405-631-1116",
            "fax_number": "405-631-1825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 SW 89TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731398514",
            "telephone_number": "405-631-1116",
            "fax_number": "405-631-1825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODGERS",
        "first_name": "MARVIN",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-18",
        "last_updated": "2010-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "2192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.