NPIMap

Individual provider Active NPI

Tracy Adelle Kidwell, D.O.

  • Family Medicine Physician
  • Midwest City, OK
National Provider Identifier
1033197496
Registry record updated Jun 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3809 Issued in OK
Practice address
1800 S Douglas Blvd
Midwest City, OK 73130-6224
Phone
(405) 741-7722
Fax
(405) 741-7757
NPI assigned
Jan 5, 2006
Last updated
Jun 10, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2022

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 3809 OK Primary

Addresses

Primary practice location

1800 S Douglas Blvd
Midwest City, OK 73130-6224

Mailing address

1800 S Douglas Blvd
Midwest City, OK 73130-6224

Other practice location 1

3700 N Kickapoo Ave
Suite 124
Shawnee, OK 74804-1707
Phone (405) 273-6383

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tracy.kidwell.1@4696.direct.athenahealth.com Direct

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
I20120829000077 OK Practitioner - Family Practice 4183790587 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saints Medical Group, LLCGroup PAC ID 7012914898, 430 clinicians

Practice addresses (Care Compare)

608 NW 9TH St
Suite 1100
Oklahoma City, OK 73102-1068
Phone (405) 231-3000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3809OKMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Saints Medical Group, LLC CurrentSince Apr 1, 2021 Accepting new patients
Saints Medical Group, LLC Family Medicine CurrentSince Apr 1, 2021 Accepting new patients
SSM Health Care of Oklahoma, Inc. Past Accepting new patients
SSM Health Care of Oklahoma, Inc Past Accepting new patients
Deaconess Physician Services LLC Family Medicine Past Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

608 NW 9th St
Ste 2200
Oklahoma City, OK 73102
Phone (405) 231-3737

608 NW 9th St
Ste 1100
Oklahoma City, OK 73102
Phone (405) 231-3000

1800 S Douglas Blvd
Oklahoma City, OK 73130
Phone (405) 732-7119

2825 Parklawn Dr
Oklahoma City, OK 73110
Phone (405) 245-1453

2401 W Wrangler Blvd
Seminole, OK 74868
Phone (405) 303-4000

3700 N Kickapoo Ave
Ste 124
Shawnee, OK 74804
Phone (405) 273-6383

Interoperability endpoints

  • Direct secure messaging: tracy.kidwell.1@4696.direct.athenahealth.com
  • Direct secure messaging: tkidwell391953@direct-ehr-ssmhc.com

Organizations & group practices 6

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 6

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": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654819200000",
    "number": "1033197496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 S DOUGLAS BLVD",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731306224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 S DOUGLAS BLVD",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731306224",
            "telephone_number": "405-741-7722",
            "fax_number": "405-741-7757"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3700 N Kickapoo Ave",
            "address_2": "Suite 124",
            "address_purpose": "LOCATION",
            "city": "Shawnee",
            "state": "OK",
            "postal_code": "748041707",
            "country_code": "US",
            "telephone_number": "405-273-6383",
            "fax_number": "405-214-1074",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIDWELL",
        "first_name": "TRACY",
        "middle_name": "ADELLE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-05",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "3809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tracy.kidwell.1@4696.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1800 S Douglas Blvd",
            "city": "Midwest City",
            "state": "OK",
            "country_code": "US",
            "postal_code": "731306224",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Midwest City, OK

Sources for this page

Verify at the official NPI Registry.