Bob R Abernathy, DO
Individual provider Active NPI Family Medicine Physician · Cordell, OK
NPI 1114920071 · NPPES record last updated Jul 18, 2016
Key facts
- NPI
- 1114920071
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 2075 (OK)
- Practice address
- 1200 N Glenn English
Cordell, OK 73632-2010 - Phone
- (580) 832-3838
- Fax
- (580) 832-5119
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100127000788 | OK | Practitioner - Family Practice |
7012059173 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2075 | OK | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cordell Memorial Hospital 0189 | Current | Accepting new patients | |
| Southern Plains Medical Center of Garvin County LLC | Current |
Accepting new patients | |
| Southern Plains Medical Center of Garvin County LLC | Current |
Accepting new patients | |
| Jackson County Memorial Hospital Authority | Past | Accepting new patients | |
| Summit Medical Center | Past | Accepting new patients | |
| Cordell Memorial Hospital 0189 | Past | Accepting new patients |
Locations
1220 N Glenn L English St
Cordell, OK 73632
Phone (580) 832-3339
1200 N Glenn L English St
Cordell, OK 73632
Phone (580) 832-3385
100 Valley Dr
Pauls Valley, OK 73075
Phone (405) 238-5501
Interoperability endpoints
- babernathy109060@direct-ehr-ssmhc.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2075 | OK | Yes |
Addresses
Primary practice location
1200 N Glenn English
Cordell, OK 73632-2010
Mailing address
1220 N Glenn L English St
Cordell, OK 73632-2010
Phone (580) 832-3339
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100101100A | Medicaid | OK | |
| 100101100C | Other | OK | SOONERCARE CHOICE |
| 125307900 | Other | OK | DOL |
| 08013806 | Other | RAILROAD MC | |
| 321802700 | Other | OK | DEPARTMENT OF LABOR |
Other providers in Cordell, OK
- Nadia Carolina Azuero
- Kimberly Bartlett
- City of New Cordell
- Clinic Pharmacy of Cordell Inc
- Comanche County Healthcare
All providers in Cordell, OK · Family Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.