Gary L Paddack, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

12905 Issued in OK

Practice address

902 Arlington Ctr
PMB 224
Ada, OK 74820-2883

Phone

(580) 436-2262

Fax

(580) 272-0186

NPI assigned

Mar 9, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michel Danette Cosby, APRN

  • Family Nurse Practitioner
  • Stratford, OK
  • NPI 1235673799
  Medicare reassignment
• Mandy Lynne Waters, APRN-CNP

  • Family Nurse Practitioner
  • Ada, OK
  • NPI 1619327970
  Medicare reassignment
• Tiffany Kay Wilson, P.A.

  • Physician Assistant
  • Henrietta, TX
  • NPI 1710920178

  OK

  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200009600000",
    "number": "1053389833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 ARLINGTON CTR",
            "address_2": "PMB 224",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748202883",
            "telephone_number": "580-436-2262",
            "fax_number": "580-272-0186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 ARLINGTON CTR",
            "address_2": "PMB 224",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748202883",
            "telephone_number": "580-436-2262",
            "fax_number": "580-272-0186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PADDACK",
        "first_name": "GARY",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2008-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "12905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100143120B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alisia Ortiz
• Vashti Osborn
• Almalita Owens
• Pack Family Clinic, PLLC (Family Physician)
• Valerie Marie Pack, D.O.
• Lyn Page, DDS
• Shrina Parekh, M.D.
• Mahate Ann Parker, M.D.
• Natalie Evonne Parker
• Wyas Goforth Parker, LMFT

• Internal Medicine Physician in Ada, OK
• Providers in Ada, OK by specialty
• Internal Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2008; 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.

Verify at the official NPI Registry.