Individual provider Active NPI

Jessica Renee Davis, PA-C

  • Physician Assistant
  • Oklahoma City, OK
National Provider Identifier
1053700849
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2454 Issued in OK
Practice address
4221 S Western Ave Ste 5050
Oklahoma City, OK 73109-3499
Phone
(405) 636-7900
Fax
(405) 644-5168
NPI assigned
Jan 15, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2454 OK Primary

Addresses

Primary practice location

4221 S Western Ave Ste 5050
Oklahoma City, OK 73109-3499

Mailing address

5300 N Independence Ave Ste 280
Oklahoma City, OK 73112-5555
Phone (405) 636-7900

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150305001645 OK Practitioner - Physician Assistant 3971829151 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integris Ambulatory Care CorporationGroup PAC ID 2365408465, 687 clinicians

Practice addresses (Care Compare)

1201 Health Ctr Pkwy
Yukon, OK 73099-6381
Phone (405) 717-6800

3400 NW Expressway
Suite 500
Oklahoma City, OK 73112-4492
Phone (405) 945-4589

4221 S Western Ave
Oklahoma City, OK 73109-3436

4401 S Western
Wound Care Clinic
Oklahoma City, OK 73109-3413
Phone (405) 636-7000

4401 S Western Ave
Oklahoma City, OK 73109-3413
Phone (405) 636-7000

4421 S Western Ave
Suite 1030
Oklahoma City, OK 73109-3413
Phone (405) 644-5398

4801 Integris Pkwy
Edmond, OK 73034-8864
Phone (405) 657-3150

4833 Integris Pkwy
Edmond, OK 73034-8864

5501 N Portland
Select Specialty Hosp West
Oklahoma City, OK 73112-2074
Phone (405) 951-4016

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2454OKMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Dec 19, 2016 Accepting new patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Dec 19, 2016 Accepting new patients
Integris Ambulatory Care C Orporation Past Accepting new patients
Amy Libel Darter MD PC Past Accepting new patients

Locations

825 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-4864

Interoperability endpoints

  • Direct secure messaging: jdavis211636@direct.integrisok.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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1421280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1053700849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 N INDEPENDENCE AVE STE 280",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731125555",
            "telephone_number": "405-636-7900",
            "fax_number": "405-644-5168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4221 S WESTERN AVE STE 5050",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731093499",
            "telephone_number": "405-636-7900",
            "fax_number": "405-644-5168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JESSICA",
        "middle_name": "RENEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-15",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.