Russell Wayne Anderson, DO
Individual provider Active NPI Emergency Medicine Physician · Tulsa, OK
NPI 1114939733 · NPPES record last updated Oct 30, 2007
Key facts
- NPI
- 1114939733
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 4498 (OK)
- Practice address
- 4500 S Garnett Rd
Ste 919
Tulsa, OK 74146-5229 - Phone
- (918) 728-6145
- Fax
- (918) 728-6146
- NPI assigned
- Aug 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 24
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Creek Nation Hospital and Clinics
Practice addresses (Care Compare)
10109 E 79TH St
Tulsa, OK 74133-4564
Phone (918) 756-4333
Hospital & facility affiliations
- Hillcrest Hospital South
- Hillcrest Medical Center
- Eastern Oklahoma Medical Center
- Bailey Medical Center, LLC
- Hillcrest Hospital Henryetta
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in OK, KS, AR, TX
- 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 |
|---|---|---|---|---|
| I20070910000266 | OK | Practitioner - Emergency Medicine | 9032116314 | Reassigns benefits to 2 organizations |
| I20150211000876 | KS | Practitioner - Emergency Medicine | 9032116314 | Reassigns benefits to 1 organization |
| I20160623000961 | AR | Practitioner - Emergency Medicine | 9032116314 | Reassigns benefits to 1 organization |
| I20211223001076 | TX | Practitioner - Emergency Medicine | 9032116314 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056948 | GA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Creek Nation Hospital & Clinics | Current |
Accepting new patients | |
| Creek Nation Hospital & Clinics | Current |
Accepting new patients | |
| Mercy Clinic Fort Smith Communities | Current |
Accepting new patients | |
| Mercy Clinic Fort Smith Communities | Current |
Accepting new patients | |
| Creek Nation Hospital & Clinics | Current |
Accepting new patients | |
| Green Country Emergency Physicians Group of Tulsa PLLC | Emergency Medicine | Current |
Accepting new patients |
| Leflore County Hospital Authority | Past | Accepting new patients | |
| Ahs Hillcrest Medical Center, LLC | Past | Accepting new patients | |
| Ahs Southcrest Hospital, LLC | Past | Accepting new patients |
Locations
7001 Rogers Ave
Ste 200
Fort Smith, AR 72903
Phone (479) 314-4620
2901 S 74th St
Fort Smith, AR 72903
Phone (479) 314-1101
7301 Rogers Ave
Fort Smith, AR 72903
Phone (479) 314-4600
1400 W 4th St
Coffeyville, KS 67337
Phone (620) 251-1200
1027 E Cherry St
Cushing, OK 74023
Phone (918) 225-2915
2401 W Main St
Henryetta, OK 74437
Phone (918) 650-1100
900 E Airport Rd
Okmulgee, OK 74447
Phone 91875643334448
10502 N 110th East Ave
Owasso, OK 74055
Phone (918) 376-8000
1125 E Cleveland Ave
Sapulpa, OK 74066
Phone (918) 224-9310
Dept 1038
Tulsa, OK 74182
Dept 1467
Tulsa, OK 74182
10109 E 79th St
Tulsa, OK 74133
Phone (888) 552-6760
1120 S Utica Ave
Tulsa, OK 74104
Phone (918) 579-6090
Interoperability endpoints
- randerson106870@ahs.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 056948 | GA | |
| Emergency Medicine Physician | 207P00000X | 4498 | OK | Yes |
Addresses
Primary practice location
4500 S Garnett Rd
Ste 919
Tulsa, OK 74146-5229
Mailing address
4500 S Garnett Rd
Ste 919
Tulsa, OK 74146-5229
Phone (918) 728-6145
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200115580A | Medicaid | OK |
Other providers in Tulsa, OK
- Rashonna Anderson
- Rayshinda Anderson
- Rebecca Danielle Anderson
- Robert Louis Anderson
- Ronald W. Anderson
- Sara Anderson
- Travis Leon Anderson
- Trevor Clayton Anderson
- Tristan Daniel Anderson
- Denise Lizbeth Andino
All providers in Tulsa, OK · Emergency 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 Oct 30, 2007. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.