Active NPI
Miracle Obeta, MA, BHRS
- Community/Behavioral Health Agency
- Yukon, OK
National Provider Identifier
1083950125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Practice address
- 2900 Cider Mill LN
Yukon, OK 73099-8843 - Phone
- (405) 541-3733
- NPI assigned
- Dec 18, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Primary |
Addresses
Primary practice location
2900 Cider Mill LN
Yukon, OK 73099-8843
Mailing address
2900 Cider Mill LN
Yukon, OK 73099-8843
Phone (405) 541-3733
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK, TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190717000529 | OK | Practitioner - Clinical Social Worker | 0446585251 | Practice locations: Yukon, OK |
| I20240814000796 | TX | Practitioner - Clinical Social Worker | 0446585251 | Practice locations: Fulshear, TX |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
Fulshear, TX 77441
Phone (405) 541-3733
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6659 | OK | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558396800000",
"number": "1083950125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 CIDER MILL LN",
"city": "YUKON",
"state": "OK",
"postal_code": "730998843",
"telephone_number": "405-541-3733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 CIDER MILL LN",
"city": "YUKON",
"state": "OK",
"postal_code": "730998843",
"telephone_number": "405-541-3733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OBETA",
"first_name": "MIRACLE",
"name_prefix": "Mr.",
"credential": "MA, BHRS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-12-18",
"last_updated": "2019-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yukon, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.