NPIMap

Organization Active NPI

Imaging Partners of Tulsa LLC

Doing business as Envision Imaging Broken Arrow

  • Diagnostic Radiology Physician
  • Broken Arrow, OK
National Provider Identifier
1114749157
Registry record updated Feb 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
IMAGING PARTNERS OF TULSA LLC
Doing business as
Envision Imaging Broken Arrow
Practice address
2544 E Kenosha St
Broken Arrow, OK 74014-6712
Phone
(918) 505-2725
NPI assigned
Oct 30, 2024
Last updated
Feb 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2025

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

Authorized official

Name
Steven Brewer
Title
Cfo
Phone
(719) 955-4332

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

2544 E Kenosha St
Broken Arrow, OK 74014-6712

Mailing address

PO Box 17388
Denver, CO 80217-0388

Other names 1

  • Envision Imaging Broken Arrow Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250304000380 OK Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1951756675 Practice locations: Broken Arrow, OK

Other NPIs with the same Medicare PAC ID 2

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
37D2316231Envision Imaging Broken Arrow2544 East Kenosha St, Broken Arrow, OK 74014Certificate of waiverDec 30, 2026

National Provider Directory

National Provider Directory
Tax ID family
Envision Imaging at Yale3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

2544 E Kenosha St
Broken Arrow, OK 74014
Phone (918) 505-2725

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738627200000",
    "number": "1114749157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17388",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802170388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2544 E KENOSHA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740146712",
            "telephone_number": "918-505-2725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGING PARTNERS OF TULSA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-30",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "719-955-4332"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Envision Imaging Broken Arrow",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Envision Imaging Broken Arrow",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 4, 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.