Individual provider Active NPI

Shon D. Kendall, D.O.

  • Emergency Medical Services (Emergency Medicine) Physician
  • Tulsa, OK
National Provider Identifier
1063402865
Registry record updated Apr 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
4084 Issued in OK
Practice address
1717 S Utica Ave Ste a
Tulsa, OK 74104-5346
Phone
(918) 748-7557
Fax
(918) 748-7514
NPI assigned
Oct 24, 2005
Last updated
Apr 13, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 13, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 4084 OK Primary

Addresses

Primary practice location

1717 S Utica Ave Ste a
Tulsa, OK 74104-5346

Mailing address

1515 N Harvard Ave
Ste E
Tulsa, OK 74115-4957
Phone (918) 832-6050

Other identifiers 1

IdentifierTypeStateIssuer
200040170AMedicaidOK

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041116000176 OK Practitioner - Emergency Medicine 1254395627 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.51 of 100Reported as group
Quality
84.87
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4084OKMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Physicians of Tulsa County, LLC CurrentSince Oct 1, 2024 Accepting new patients
St. John Physicians, Inc CurrentSince May 1, 2010 Accepting new patients
St. John Physicians, Inc. CurrentSince May 1, 2010 Accepting new patients
St John Urgent Care Clinics Inc Past Accepting new patients
Owasso Medical Facility, Inc Past Accepting new patients
St. John Broken Arrow, Inc Past Accepting new patients
St John Sapulpa, Inc. Past Accepting new patients

Locations

1000 W Boise Cir
Broken Arrow, OK 74012
Phone (918) 994-8000

12451 E 100th St N
Owasso, OK 74055
Phone (918) 274-5000

1004 E Bryan Ave
Sapulpa, OK 74066
Phone (918) 224-4280

10501 E 91st St
Tulsa, OK 74133
Phone (918) 307-6000

1515 N Harvard Ave
Ste E
Tulsa, OK 74115
Phone (918) 832-6049

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

1705 E 19th St
Ste 304
Tulsa, OK 74104
Phone (918) 748-7660

1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345

Interoperability endpoints

  • Direct secure messaging: shon.kendall.1@18337.direct.athenahealth.com
  • Direct secure messaging: shon.kendall@direct.stjohnhealthsystem.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271116800000",
    "number": "1063402865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 N HARVARD AVE",
            "address_2": "STE E",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741154957",
            "telephone_number": "918-832-6050",
            "fax_number": "918-832-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S UTICA AVE STE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045346",
            "telephone_number": "918-748-7557",
            "fax_number": "918-748-7514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENDALL",
        "first_name": "SHON",
        "middle_name": "D.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-24",
        "last_updated": "2010-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "OK",
            "license": "4084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200040170A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.