Active NPI
Todd K Pogue, DO
- Psychiatry Physician
- Tahlequah, OK
National Provider Identifier
1083659635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 4110
- Practice address
- 1325 E Boone St
Tahlequah, OK 74464-3361 - Phone
- (918) 207-4977
- NPI assigned
- Jun 18, 2006
- Last updated
- Oct 22, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 15
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | CL0056 | NV | |
| Psychiatry Physician | 2084P0800X | DO-03788 | IA | |
| Psychiatry Physician | 2084P0800X | MED-PHYS-LIC-78691 | MT | |
| Psychiatry Physician | 2084P0800X | OC-0046 | ID | |
| Psychiatry Physician | 2084P0800X | 27016 | MS | |
| Psychiatry Physician | 2084P0800X | 66313 | MN | |
| Psychiatry Physician | 2084P0800X | 15992 | ND | |
| Psychiatry Physician | 2084P0800X | 19988 | NH | |
| Psychiatry Physician | 2084P0800X | 3863 | TN | |
| Psychiatry Physician | 2084P0800X | 11452352-1204 | UT | |
| Psychiatry Physician | 2084P0800X | 2098 | NE | |
| Psychiatry Physician | 2084P0800X | 05-42575 | KS | |
| Psychiatry Physician | 2084P0800X | 4110 | OK | Primary |
| Psychiatry Physician | 2084P0800X | H88263 | MD | |
| Psychiatry Physician | 2084P0800X | M8922 | TX |
Addresses
Primary practice location
1325 E Boone St
Tahlequah, OK 74464-3361
Mailing address
1325 E Boone St
Tahlequah, OK 74464-3361
Phone (918) 207-4977
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DO-03788 | IA | MD | Psychiatry Physician |
| OC-0046 | ID | MD | Psychiatry Physician |
| 05-42575 | KS | MD | Psychiatry Physician |
| H88263 | MD | MD | Psychiatry Physician |
| 66313 | MN | MD | Psychiatry Physician |
| 27016 | MS | MD | Psychiatry Physician |
| MED-PHYS-LIC-78691 | MT | MD | Psychiatry Physician |
| 15992 | ND | MD | Psychiatry Physician |
| 2098 | NE | MD | Psychiatry Physician |
| 19988 | NH | MD | Psychiatry Physician |
| CL0056 | NV | MD | Psychiatry Physician |
| M8922 | TX | MD | Psychiatry Physician |
| 11452352-1204 | UT | MD | Psychiatry Physician |
| 4110 | OK | MD | Physical Therapist |
| 3863 | TN | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bridgeway Inc | Past | Accepting new patients | |
| Bridgeway Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Pekin, IL
- NPI 1346524899
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Normal, IL
- NPI 1588948046
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571702400000",
"number": "1083659635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1325 E BOONE ST",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744643361",
"telephone_number": "918-207-4977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1325 E BOONE ST",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744643361",
"telephone_number": "918-207-4977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POGUE",
"first_name": "TODD",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-18",
"last_updated": "2019-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NV",
"license": "CL0056",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IA",
"license": "DO-03788",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MT",
"license": "MED-PHYS-LIC-78691",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "ID",
"license": "OC-0046",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MS",
"license": "27016",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MN",
"license": "66313",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "ND",
"license": "15992",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NH",
"license": "19988",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TN",
"license": "3863",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "UT",
"license": "11452352-1204",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NE",
"license": "2098",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "KS",
"license": "05-42575",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "OK",
"license": "4110",
"primary": true
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MD",
"license": "H88263",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TX",
"license": "M8922",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Tahlequah, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.