NPIMap

Individual provider Active NPI

Anna Stidham, M.D.

  • Diagnostic Radiology Physician
  • Oklahoma City, OK
National Provider Identifier
1114066180
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
23436 Issued in OK
Practice address
1200 Everett Dr
1 NP 606
Oklahoma City, OK 73104-5047
Phone
(405) 271-5125
NPI assigned
Feb 6, 2007
Last updated
Apr 23, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 23436 OK Primary

Addresses

Primary practice location

1200 Everett Dr
1 NP 606
Oklahoma City, OK 73104-5047

Mailing address

940 Stanton L Young Blvd
BMSB 357
Oklahoma City, OK 73104-5020

Other practice location 1

8516 S Portland Ave
Oklahoma City, OK 73159-2233
Phone (405) 768-1970

Other identifiers 1

IdentifierTypeStateIssuer
200134480AMedicaidOK

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
I20080430000758 OK Practitioner - Diagnostic Radiology 5991884017 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Oklahoma College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oklahoma Radiology Group P CGroup PAC ID 9032101688, 59 clinicians
Comprehensive Diagnostic Imaging LLCGroup PAC ID 9638327620, 5 clinicians
Oklahoma Prostate Imaging LLCGroup PAC ID 5193174761, 2 clinicians
Premier Breast Health Institute of Oklahoma LLCGroup PAC ID 6406202753, 4 clinicians

Practice addresses (Care Compare)

1000 N Lee Ave
Oklahoma City, OK 73102-1036
Phone (405) 272-7000

5800 N Portland Ave
Oklahoma City, OK 73112-1661
Phone (405) 601-4500

8516 S Portland Ave
Oklahoma City, OK 73159-6477
Phone (405) 778-3141

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
50 of 100Reported as group
Quality
0
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
95 of 100Reported as group
Quality
90
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
23436OKMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
Oklahoma Proton Center LLC CurrentSince May 1, 2024 Accepting new patients
Creek Nation Hospital & Clinics Current Accepting new patients
Creek Nation Hospital & Clinics CurrentSince May 31, 2016 Accepting new patients
Premier Breast Health Institute of Oklahoma LLC Diagnostic Radiology CurrentSince Sep 1, 2023 Accepting new patients
Oklahoma Radiology Group P C Diagnostic Radiology CurrentSince Dec 25, 2016 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince May 31, 2016 Accepting new patients
Oklahoma Prostate Imaging, LLC CurrentSince Aug 1, 2024 Accepting new patients
University of Oklahoma College of Medicine Diagnostic Radiology Past Accepting new patients
Ou Health Partners, Inc Past Accepting new patients

Locations

212 E 8th St
Beaver, OK 73932
Phone (580) 625-3646

1220 N Glenn L English St
Cordell, OK 73632
Phone (580) 832-3339

523 E State Rd
Fairview, OK 73737
Phone (580) 227-1334

1000 N Lee Ave
Oklahoma City, OK 73102
Phone (405) 272-6152

11200 N Portland Ave
Oklahoma City, OK 73120
Phone (405) 936-1000

5901 W Memorial Rd
Oklahoma City, OK 73142
Phone (405) 773-6700

1401 Morris Dr
Okmulgee, OK 74447
Phone (918) 456-0641

900 E Airport Rd
Okmulgee, OK 74447
Phone 91875643334448

1500 N Green Ave
Purcell, OK 73080
Phone (405) 527-2250

3315 Kethley Rd
Shawnee, OK 74804
Phone (405) 273-5801

10109 E 79th St
Tulsa, OK 74133
Phone (888) 552-6760

Dept 1467
Tulsa, OK 74182

1601 Health Center Pkwy
Ste 1000
Yukon, OK 73099
Phone (405) 265-2210

Interoperability endpoints

  • Direct secure messaging: astidham@yourcarecommunity.org

Organizations & group practices 10

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 7

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": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1114066180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 STANTON L YOUNG BLVD",
            "address_2": "BMSB 357",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 EVERETT DR",
            "address_2": "1 NP 606",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045047",
            "telephone_number": "405-271-5125"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8516 S Portland Ave",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731592233",
            "country_code": "US",
            "telephone_number": "405-768-1970",
            "fax_number": "405-438-3993",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STIDHAM",
        "first_name": "ANNA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-06",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OK",
            "license": "23436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200134480A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.