NPIMap

Organization Active NPI

Family Care of Broken Arrow, Inc.

Doing business as Family Medicine Associates

  • Family Medicine Physician
  • Broken Arrow, OK
National Provider Identifier
1053431452
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAMILY CARE OF BROKEN ARROW, INC.
Doing business as
Family Medicine Associates
Practice address
3100 S. Elm PL.
Suite a
Broken Arrow, OK 74012-7910
Phone
(918) 455-7777
Fax
(918) 455-8105
NPI assigned
Mar 30, 2007
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Dr. Leroy O. Jeske, D.O.NPI 1205839446
Title
Medical Director D.O.
Phone
(918) 455-7777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

3100 S. Elm PL.
Suite a
Broken Arrow, OK 74012-7910

Mailing address

3100 S. Elm PL.
Suite a
Broken Arrow, OK 74012-7910
Phone (918) 455-7777

Other identifiers 2

IdentifierTypeStateIssuer
0749960001OtherOKPTAN/DMERC
CS2603OtherOKRAILROAD MEDICARE

Other names 1

  • Family Medicine Associates Doing business as

National Provider Directory

National Provider Directory

Locations

3100 S Elm Pl
Ste A
Broken Arrow, OK 74012
Phone (918) 455-7777

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1053431452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 S. ELM PL.",
            "address_2": "SUITE A",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740127910",
            "telephone_number": "918-455-7777",
            "fax_number": "918-455-8105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 S. ELM PL.",
            "address_2": "SUITE A",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740127910",
            "telephone_number": "918-455-7777",
            "fax_number": "918-455-8105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE OF BROKEN ARROW, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "JESKE",
        "authorized_official_first_name": "LEROY",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR D.O.",
        "authorized_official_telephone_number": "918-455-7777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN/DMERC",
            "identifier": "0749960001",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CS2603",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.