Individual provider Active NPI

Jeanne M Schaefer, MD

  • Pediatrics Physician
  • Edmond, OK
National Provider Identifier
1114992740
Registry record updated Jul 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
18963 Issued in OK
Practice address
523 S Santa Fe Ave Ste B
Edmond, OK 73003-6291
Phone
(405) 509-6777
Fax
(405) 509-6778
NPI assigned
Feb 17, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 18963 OK Primary

Addresses

Primary practice location

523 S Santa Fe Ave Ste B
Edmond, OK 73003-6291

Mailing address

PO Box 270
Edmond, OK 73083-0270
Phone (405) 509-6777

Other identifiers 1

IdentifierTypeStateIssuer
100205560BMedicaidOK

Other names 1

  • Jeanne M Schaefer-Sims Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
18963OKMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Jeanne M Schaefer MD PLLC Pediatrics CurrentSince Aug 16, 2020 Accepting new patients
Summit Medical Center Past Accepting new patients
Aky MD, LLC Pediatrics Past Accepting new patients

Locations

1700 Renaissance Blvd
Edmond, OK 73013
Phone (405) 844-3800

523 S Santa Fe Ave
Ste B
Edmond, OK 73003
Phone (405) 285-0660

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.973232

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594944000000",
    "number": "1114992740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730830270",
            "telephone_number": "405-509-6777",
            "fax_number": "405-509-6778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 S SANTA FE AVE STE B",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730036291",
            "telephone_number": "405-509-6777",
            "fax_number": "405-509-6778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHAEFER",
        "first_name": "JEANNE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "18963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100205560B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEANNE",
            "last_name": "SCHAEFER-SIMS",
            "middle_name": "M",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.