NPIMap

Organization Active NPI

Oklahoma Otolaryngology Associates, LLC

  • Specialist
  • Oklahoma City, OK
National Provider Identifier
1124118773
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
OKLAHOMA OTOLARYNGOLOGY ASSOCIATES, LLC
Practice address
3033 NW 63Rd Street
152E
Oklahoma City, OK 73116-3634
Phone
(405) 755-6651
Fax
(405) 755-2795
NPI assigned
Oct 13, 2006
Last updated
May 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

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

Authorized official

Name
Jeremy A Moore, M.D.NPI 1184707143
Title
President
Phone
(405) 755-6651

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

3033 NW 63Rd Street
152E
Oklahoma City, OK 73116-3634

Mailing address

P.O. Box 96-0119
Oklahoma City, OK 73196-0119
Phone (405) 755-6651

Other names 1

  • Oklahoma Otolaryngology Associates, PC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050407000414 OK Part B Supplier - Clinic/Group Practice 9739136102 Receives reassigned benefits from 15 practitioners
Practice locations: Oklahoma City, OK; Yukon, OK; Norman, OK; Ardmore, OK; Chickasha, OK; Edmond, OK

National Provider Directory

National Provider Directory

Locations

501 E 15th St
Ste 300A
Edmond, OK 73013
Phone (405) 285-5616

2272 36th Ave NW
#100
Norman, OK 73072
Phone (405) 364-2666

3650 W Rock Creek Rd
#110B
Norman, OK 73072
Phone (405) 755-1930

10001 Broadway Ext
Oklahoma City, OK 73114
Phone (405) 748-5950

1601 SW 89th St
Ste C500
Oklahoma City, OK 73159
Phone (405) 605-4368

3033 NW 63rd St
#152E
Oklahoma City, OK 73116
Phone (405) 755-6651

3330 NW 56th St
Ste 110
Oklahoma City, OK 73112
Phone (405) 595-3575

5701 N Portland Ave
Ste 305
Oklahoma City, OK 73112
Phone (405) 604-4475

6201 N Santa Fe Ave
Ste 2020
Oklahoma City, OK 73118
Phone (405) 272-5433

4415 S Harvard Ave
Ste 125
Tulsa, OK 74135
Phone (918) 508-7601

Practitioners & affiliated clinicians

Practitioners 42

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 42

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684108800000",
    "number": "1124118773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 96-0119",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731960119",
            "telephone_number": "405-755-6651",
            "fax_number": "405-755-2795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3033 NW 63RD STREET",
            "address_2": "152E",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731163634",
            "telephone_number": "405-755-6651",
            "fax_number": "405-755-2795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OKLAHOMA OTOLARYNGOLOGY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-755-6651",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oklahoma Otolaryngology Associates, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Oklahoma Otolaryngology Associates, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 15, 2023; 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.