NPIMap

Organization Active NPI

Oklahoma Proton Center LLC

  • Radiation Oncology Clinic/Center
  • Oklahoma City, OK
National Provider Identifier
1114408762
Registry record updated May 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology Clinic/CenterTaxonomy code 261QX0203X
Legal business name
OKLAHOMA PROTON CENTER LLC
Practice address
5901 W Memorial Rd
Oklahoma City, OK 73142-2015
Phone
(918) 798-9160
NPI assigned
Aug 22, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2022

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

Authorized official

Name
Mr. David James Raubach
Title
Officer
Phone
(918) 798-9160

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Clinic/Center 261QX0203X Primary

Addresses

Primary practice location

5901 W Memorial Rd
Oklahoma City, OK 73142-2015

Mailing address

PO Box 218
Lowell, AR 72745-0218
Phone (866) 317-3801

Other practice location 1

3300 NW 56th St
Oklahoma City, OK 73112-4538
Phone (405) 773-6700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190225000069 OK Part B Supplier - Radiation Therapy Center 4183963861 Receives reassigned benefits from 28 practitioners
Practice locations: Oklahoma City, OK; Ponca City, OK; Muskogee, OK; Moore, OK; Edmond, OK

National Provider Directory

National Provider Directory

Locations

3505 NW 56th St
Oklahoma City, OK 73112
Phone (405) 773-6700

Practitioners & affiliated clinicians

Practitioners 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1534896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651795200000",
    "number": "1114408762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 218",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727450218",
            "telephone_number": "866-317-3801",
            "fax_number": "512-583-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 W MEMORIAL RD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731422015",
            "telephone_number": "918-798-9160"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3300 NW 56th St",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731124538",
            "country_code": "US",
            "telephone_number": "405-773-6700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OKLAHOMA PROTON CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-22",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A",
        "authorized_official_last_name": "RAUBACH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "918-798-9160",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QX0203X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology, Radiation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; 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.