Mitsi A Faubion, DO
Individual provider Active NPI Family Medicine Physician · Clayton, OK
NPI 1063408656 · NPPES record last updated Oct 18, 2016
Key facts
- NPI
- 1063408656
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 4294 (OK)
- Practice address
- 109 Stanley Rd
Clayton, OK 74536-0219 - Phone
- (918) 569-4143
- Fax
- (918) 569-7343
- NPI assigned
- Sep 20, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Oklahoma State University College of Osteopathic Medicine, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- South Central Medical and Resource Center Inc
Practice addresses (Care Compare)
216 S Main St
Lindsay, OK 73052-5634
Phone (405) 756-1414
2222 W Iowa Ave
Chickasha, OK 73018-2738
Phone (405) 756-1414
Hospital & facility affiliations
- Norman Regional
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161102000156 | OK | Practitioner - Family Practice | 2860421088 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4294 | OK | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Signify Health, LLC | Current |
Accepting new patients | |
| South Central Medical and Resource Center Inc. | Current |
Accepting new patients | |
| Pushmataha Family Medical Center Inc | Past |
Accepting new patients |
Locations
2222 W Iowa Ave
Chickasha, OK 73018
902 W Chickasha Ave
Chickasha, OK 73018
216 S Main St
Lindsay, OK 73052
Phone (405) 756-4303
707 W Comanche
Lindsay, OK 73052
Phone 4057561414 ext. 122
707 W Comanche
Lindsay, OK 73052
102 S Main St
Lindsay, OK 73052
504 Williams
Maysville, OK 73057
Phone (405) 867-4404
10601 S Western Ave
Ste 100
Oklahoma City, OK 73170
200 Melville Dr
Pauls Valley, OK 73075
Phone (405) 238-5555
109 E Kirby St
Washington, OK 73093
Phone (405) 288-1057
101 E Kerby St
Washington, OK 73093
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/GEIDAA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4294 | OK | Yes |
Addresses
Primary practice location
109 Stanley Rd
Clayton, OK 74536-0219
Mailing address
PO Box 67
Milburn, OK 73450-0067
Phone (580) 443-3533
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200072150B | Medicaid | OK |
Other providers in Clayton, OK
- Heather Janelle Blagg
- Paula Sue Brown
- Clayton Pharmacy
- Clayton Public School
- Curatio Hospice Inc
- Jason S Graves
- Gerald N Harper
- Rita Cheryl Linker
- Ernest B Perkins
- Jacob Lynn Peters
All providers in Clayton, OK · Family Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.