NPIMap

Individual provider Active NPI

Jack Connor Wilkinson, MD

  • Surgery Physician
  • Oklahoma City, OK
National Provider Identifier
1053976670
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
34747 Issued in OK
Practice address
800 Stanton L Young Blvd # 9432
Oklahoma City, OK 73104-5018
Phone
(405) 271-6308
NPI assigned
May 8, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 34747 OK Primary

Addresses

Primary practice location

800 Stanton L Young Blvd # 9432
Oklahoma City, OK 73104-5018

Mailing address

800 Stanton L Young Blvd # 9432
Oklahoma City, OK 73104-5018

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
I20240729000313 OK Practitioner - General Surgery 5294062329 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Oklahoma College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

110 NW 31St St
FL 3
Lawton, OK 73505-6100
Phone (580) 510-7042

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy90
Hernia repair (minimally invasive)1-10
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux98
Melanoma (skin cancer) excision13
Removal of tissue20

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34747OKMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Comanche County Healthcare Corporation CurrentSince Jul 1, 2024 Accepting new patients
Comanche County Healthcare Corporation CurrentSince Jul 1, 2024 Accepting new patients
Comanche County Healthcare Corporation Current Accepting new patients
Comanche County Hospital Authority Past Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Comanche County Hospital Authority Past Accepting new patients
Comanche County Healthcare Surgery Past Accepting new patients

Locations

3201 W Gore Blvd
Ste 300
Lawton, OK 73505
Phone (580) 248-5255

3401 W Gore Blvd
Lawton, OK 73505
Phone (580) 483-5207

3201 W Gore Blvd
Ste 201
Lawton, OK 73505
Phone (580) 357-2261

110 NW 31st St
Fl 3
Lawton, OK 73505
Phone (580) 250-5200

Organizations & group practices 7

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 5

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": "1557273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1053976670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 STANTON L YOUNG BLVD # 9432",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 STANTON L YOUNG BLVD # 9432",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045018",
            "telephone_number": "405-271-6308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKINSON",
        "first_name": "JACK",
        "middle_name": "CONNOR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-08",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OK",
            "license": "34747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.