NPIMap

Individual provider Active NPI

Matthew M Diesselhorst, MD

  • Orthopaedic Surgery Physician
  • Oklahoma City, OK
National Provider Identifier
1104022417
Registry record updated Apr 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
25730 Issued in OK
Practice address
10914 Hefner Pointe Dr Ste 200
Oklahoma City, OK 73120-5069
Phone
(405) 463-3337
Fax
(405) 463-3338
NPI assigned
Jun 23, 2007
Last updated
Apr 7, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 25730 OK Primary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 25730 OK
Orthopaedic Trauma Physician 207XX0801X 25730 OK

Addresses

Primary practice location

10914 Hefner Pointe Dr Ste 200
Oklahoma City, OK 73120-5069

Mailing address

10914 Hefner Pointe Dr Ste 200
Oklahoma City, OK 73120-5069
Phone (405) 463-3337

Other identifiers 1

IdentifierTypeStateIssuer
25730OtherOKMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130830000543 OK Practitioner - Orthopedic SurgeryPractitioner - Sports Medicine 0840448262 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic SurgeryAlso: Sports Medicine
Education
University of Oklahoma College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1000 Hospital Dr
Kingfisher, OK 73750-5029
Phone (405) 463-3337

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Knee replacement19
Lower limb (leg) arthroscopy (minimally invasive joint repair)15
Upper limb (arm) arthroscopy (minimally invasive joint repair)15
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25730OKMDOrthopaedic Trauma Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Physicians Group LLC Orthopaedic Surgery CurrentSince Apr 1, 2020 Accepting new patients
Dso PLLC Orthopaedic Surgery CurrentSince Jun 7, 2024 Accepting new patients
Oklahoma Center for Orthopaedic & Multi-Specialty Surgery, LLC Past Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

1000 Hospital Dr
Kingfisher, OK 73750
Phone (405) 375-3141

10021 S Western Ave
Oklahoma City, OK 73139
Phone (405) 692-9300

10914 Hefner Pointe Dr
Ste 200
Oklahoma City, OK 73120
Phone (405) 463-3337

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/ed29dd2e-7f6b-4b48-93ba-6ba78c79cd2d/

Organizations & group practices 5

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1182556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586217600000",
    "number": "1104022417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10914 HEFNER POINTE DR STE 200",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731205069",
            "telephone_number": "405-463-3337",
            "fax_number": "405-463-3338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10914 HEFNER POINTE DR STE 200",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731205069",
            "telephone_number": "405-463-3337",
            "fax_number": "405-463-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIESSELHORST",
        "first_name": "MATTHEW",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-23",
        "last_updated": "2020-04-07",
        "certification_date": "2020-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "OK",
            "license": "25730",
            "primary": true
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "OK",
            "license": "25730",
            "primary": false
        },
        {
            "code": "207XX0801X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Trauma",
            "state": "OK",
            "license": "25730",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "25730",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.