NPIMap

Organization Active NPI

Oklahoma Cancer Specialists and Research Institute LLC

  • MOHS-Micrographic Surgery Physician
  • Broken Arrow, OK
National Provider Identifier
1104291236
Registry record updated Aug 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
Legal business name
OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE LLC
Practice address
800 W Boise Cir Ste 400
Broken Arrow, OK 74012-4974
Phone
(918) 307-0215
Fax
(918) 250-7669
NPI assigned
Dec 1, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2025

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

Authorized official

Name
Dr. Daron G. Street, M.D.NPI 1083656912
Title
President
Phone
(918) 505-3200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X Primary
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

800 W Boise Cir Ste 400
Broken Arrow, OK 74012-4974

Mailing address

12697 E 51St St
Tulsa, OK 74146-6236
Phone (918) 307-0215

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160115001766 OK Part B Supplier - Clinic/Group Practice 0042513558 Receives reassigned benefits from 72 practitioners
5 other NPIs on this enrollment
Practice locations: Bartlesville, OK; Broken Arrow, OK; McAlester, OK; Stillwater, OK; Tulsa, OK

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D0681101Oklahoma Cancer Specialist & Research Institute800 W. Boise Circle, Suite 400, Broken Arrow, OK 74012ComplianceMar 28, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 77

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 77

NPI Registry JSON

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

{
    "created_epoch": "1448928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754870400000",
    "number": "1104291236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12697 E 51ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741466236",
            "telephone_number": "918-307-0215",
            "fax_number": "918-250-7669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 W BOISE CIR STE 400",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740124974",
            "telephone_number": "918-307-0215",
            "fax_number": "918-250-7669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-01",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A",
        "authorized_official_last_name": "STREET",
        "authorized_official_first_name": "DARON",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-505-3200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.