Individual provider Active NPI

Ky Goodwin Dorsey, M.D.

  • Psychiatry Physician
  • Tulsa, OK
National Provider Identifier
1104054451
Registry record updated May 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
9661820-1205 Issued in UT
Practice address
4444 E 41St St
Tulsa, OK 74135-2527
Phone
(918) 619-4400
Fax
(918) 660-3132
NPI assigned
Jun 25, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 39042 OK
Psychiatry Physician 2084P0800X 9661820-1205 UT Primary

Addresses

Primary practice location

4444 E 41St St
Tulsa, OK 74135-2527

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128

Other practice location 1

4401 Harrison Blvd
Ogden, UT 84403-3195
Phone (801) 387-5502

Other identifiers 1

IdentifierTypeStateIssuer
201085580AMedicaidOK

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Bluemark LLC/ Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, OK2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160609002323 UT Practitioner - Psychiatry 4688964240 Reassigns benefits to 1 organization
I20220919003331 OK Practitioner - Psychiatry 4688964240 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Oklahoma College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1111 S St Louis Ave
Tulsa, OK 74120
Phone (918) 619-4400

Hospital & facility affiliations

  • Saint Francis Hospital, Inc Hospital, Tulsa, OK, CCN 370091

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Regents of the University of Oklahoma Ou Physicians Tulsa CurrentSince Aug 1, 2022 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services, Inc. Psychiatry CurrentSince Jul 1, 2016 Accepting new patients
State of Oklahoma Current Accepting new patients
Ihc Health Services Inc CurrentSince Jul 1, 2016 Accepting new patients
State of Oklahoma CurrentSince Sep 1, 2022 Accepting new patients
State of Oklahoma CurrentSince Sep 1, 2022 Accepting new patients
Laureate Psychiatric Clinic and Hospital Inc Past Accepting new patients

Locations

4444 E 41st St
Tulsa, OK 74135

4502 E 41st St
Ste 1J40
Tulsa, OK 74135

2323 S Harvard Ave
Tulsa, OK 74114
Phone (918) 293-2140

1111 S Saint Louis Ave
Tulsa, OK 74120
Phone (918) 619-4600

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

3903 Medical Dr
Ste 300
Ogden, UT 84403
Phone (801) 387-5600

4401 Harrison Blvd
South Ogden, UT 84403
Phone (801) 387-2800

1300 SE Cardinal Ct
Ste 190
Vancouver, WA 98683
Phone (360) 448-4479

Interoperability endpoints

  • Direct secure messaging: kdorsey28065@ouhealth.direct-ci.net

Organizations & group practices 8

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.

Hospital & facility affiliations 2

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": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778630400000",
    "number": "1104054451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4444 E 41ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741352527",
            "telephone_number": "918-619-4400",
            "fax_number": "918-660-3132"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4401 Harrison Blvd",
            "address_purpose": "LOCATION",
            "city": "Ogden",
            "state": "UT",
            "postal_code": "844033195",
            "country_code": "US",
            "telephone_number": "801-387-5502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DORSEY",
        "first_name": "KY",
        "middle_name": "GOODWIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-25",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OK",
            "license": "39042",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "UT",
            "license": "9661820-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201085580A",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC/ Office Ally",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.