NPIMap

Organization Active NPI

Northeast Oklahoma Physician Network Inc

  • Family Medicine Physician
  • Broken Arrow, OK
National Provider Identifier
1114283025
Registry record updated Jun 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTHEAST OKLAHOMA PHYSICIAN NETWORK INC
Practice address
1130 E Lansing St
Broken Arrow, OK 74012-2429
Phone
(918) 258-9990
Fax
(918) 994-4277
NPI assigned
Apr 4, 2012
Last updated
Jun 19, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2012

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

Authorized official

Name
Richard Ferguson
Title
Ceo
Phone
(918) 477-5049

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X

Addresses

Primary practice location

1130 E Lansing St
Broken Arrow, OK 74012-2429

Mailing address

2408 E 81St St
Ste 300
Tulsa, OK 74137-4200
Phone (918) 477-5049

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120725000427 OK Part B Supplier - Clinic/Group Practice 8527224252 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
Practice locations: Broken Arrow, OK; Tulsa, OK

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

1130 E Lansing St
Broken Arrow, OK 74012
Phone (918) 258-9111

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DIHBDD

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1333497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340064000000",
    "number": "1114283025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2408 E 81ST ST",
            "address_2": "STE 300",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741374200",
            "telephone_number": "918-477-5049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 E LANSING ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740122429",
            "telephone_number": "918-258-9990",
            "fax_number": "918-994-4277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST OKLAHOMA PHYSICIAN NETWORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-04",
        "last_updated": "2012-06-19",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-477-5049"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "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 Jun 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.