NPIMap

Organization Active NPI

Medwise LLC

  • Durable Medical Equipment & Medical Supplies
  • Owasso, OK
National Provider Identifier
1104626274
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
MEDWISE LLC
Practice address
11760 E 86TH St N
Owasso, OK 74055-2533
Phone
(918) 998-9961
NPI assigned
Mar 17, 2025
Organization subpart
Yes
Parent organization
MEDWISE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

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

Authorized official

Name
Dennis Sidney Blackstad, MD
Title
President
Phone
(918) 605-6582

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

11760 E 86TH St N
Owasso, OK 74055-2533

Mailing address

12902 E 51St St
Tulsa, OK 74134-6712

Other names 1

  • MedWise Urgent Care - Owasso Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250509001955 OK DME Supplier - Other 8820410970 Practice locations: Owasso, OK

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
37D2225964Medwise, LLC11760 E 86TH St North, Owasso, OK 74055Certificate of waiverMay 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Medwise LLC5 organizations share this tax ID, including this one
Part of
Medwise LLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11760 E 86th St N
Owasso, OK 74055
Phone (918) 272-2829

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21352/brand/1/csg/1/fhir/r4

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1742169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742169600000",
    "number": "1104626274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12902 E 51ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741346712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11760 E 86TH ST N",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "740552533",
            "telephone_number": "918-998-9961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDWISE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDWISE LLC",
        "enumeration_date": "2025-03-17",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A",
        "authorized_official_last_name": "BLACKSTAD",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "SIDNEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-605-6582",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedWise Urgent Care - Owasso",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Owasso, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.