Individual provider Active NPI

Robert Jeffrey Wright, DO

  • Family Medicine Physician
  • Broken Arrow, OK
National Provider Identifier
1083646541
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OK1989 Issued in OK
Practice address
800 W Boise Cir Ste 160
Broken Arrow, OK 74012-4932
Phone
(918) 994-9160
Fax
(918) 403-6306
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OK1989 OK Primary

Addresses

Primary practice location

800 W Boise Cir Ste 160
Broken Arrow, OK 74012-4932

Mailing address

800 W Boise Cir Ste 160
Broken Arrow, OK 74012-4932
Phone (189) 949-1609

Other identifiers 1

IdentifierTypeStateIssuer
100089290AMedicaidOK

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
I20110113000393 OK Practitioner - Family Practice 8426070194 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OK1989OKMDFamily Medicine Physician
1989OKMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Omni Medical Group Inc Family Medicine CurrentSince Jul 6, 2015 Accepting new patients
St. John Physicians, Inc. Family Medicine CurrentSince Jul 6, 2015 Accepting new patients
St. John Physicians, Inc CurrentSince Jul 6, 2015 Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

5050 E Kenosha St
Broken Arrow, OK 74014
Phone (918) 355-9492

800 W Boise Cir
Ste 160
Broken Arrow, OK 74012
Phone (918) 994-9160

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

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

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

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1083646541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 W BOISE CIR STE 160",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740124932",
            "telephone_number": "189-949-1609",
            "fax_number": "918-403-6306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 W BOISE CIR STE 160",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740124932",
            "telephone_number": "918-994-9160",
            "fax_number": "918-403-6306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRIGHT",
        "first_name": "ROBERT",
        "middle_name": "JEFFREY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "OK1989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100089290A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

Verify at the official NPI Registry.