Active NPI
Erich H Muckala, DO
- Diagnostic Radiology Physician
- Tulsa, OK
National Provider Identifier
1043411283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 5023
- Practice address
- 4500 S Garnett Rd
Ste 300
Tulsa, OK 74146-5229 - Phone
- (918) 728-6194
- Fax
- (918) 664-0267
- NPI assigned
- May 29, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 58.002032 | OH | |
| Diagnostic Radiology Physician | 2085R0202X | 5023 | OK | Primary |
Addresses
Primary practice location
4500 S Garnett Rd
Ste 300
Tulsa, OK 74146-5229
Mailing address
4500 S Garnett Rd
Ste 300
Tulsa, OK 74146-5229
Phone (918) 728-6194
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 58.002032 | Other | OH | TRAINING LICENSE |
| 5023 | Other | OK | STATE MEDICAL LISCENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK, IN, OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 3
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111109000852 | OK | Practitioner - Diagnostic Radiology | 5496928376 | Reassigns benefits to 1 organization |
| I20220829000903 | IN | Practitioner - Diagnostic Radiology | 5496928376 | Reassigns benefits to 1 organization |
| I20260223002914 | OH | Practitioner - Diagnostic Radiology | 5496928376 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Diagnostic Radiology
- Education
- Oklahoma State University College of Osteopathic Medicine, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
416 E Maumee St
Angola, IN 46703-2015
Phone (260) 667-5136
5000 Tower Bridge CT
Edmond, OK 73034-0857
Phone (918) 557-9191
Hospital & facility affiliations
- Kettering Health Main Campus
- Soin Medical Center
- Kettering Health Dayton
- Kettering Health Miamisburg
- Springfield Regional Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 77.41 of 100
- Quality
- 73.46
- Improvement activities
- 40
- Cost
- 73.34
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58.002032 | OH | MD | Diagnostic Radiology Physician |
| 5023 | OK | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henry County Hospital Inc | Current | Accepting new patients | |
| Ctca Physicans Group of Oklahoma, Inc | Past | Accepting new patients | |
| Diagnostic Imaging Associates Inc | Diagnostic Radiology | Past | Accepting new patients |
Locations
1600 E Riverview Ave
Napoleon, OH 43545
Phone (260) 344-3045
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 and National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Kettering, OH
- NPI 1346299153
IN, OK
-
- Specialist
- Tulsa, OK
- NPI 1053309591
-
- Diagnostic Radiology Physician
- Tulsa, OK
- NPI 1427049956
Diagnostic Radiology
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": "1180396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333411200000",
"number": "1043411283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 S GARNETT RD",
"address_2": "STE 300",
"city": "TULSA",
"state": "OK",
"postal_code": "741465229",
"telephone_number": "918-728-6194",
"fax_number": "918-664-0267"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 S GARNETT RD",
"address_2": "STE 300",
"city": "TULSA",
"state": "OK",
"postal_code": "741465229",
"telephone_number": "918-728-6194",
"fax_number": "918-664-0267"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUCKALA",
"first_name": "ERICH",
"middle_name": "H",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-29",
"last_updated": "2012-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "OH",
"license": "58.002032",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "OK",
"license": "5023",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRAINING LICENSE",
"identifier": "58.002032",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE MEDICAL LISCENSE",
"identifier": "5023",
"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 Apr 3, 2012; 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.
- 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.