NPIMap

Individual provider Active NPI

Daniel Nelson Fong, MD

  • Obstetrics & Gynecology Physician
  • Oklahoma City, OK
National Provider Identifier
1124224431
Registry record updated Apr 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
25623 Issued in OK
Practice address
11200 N Portland Ave
Oklahoma City, OK 73120-5045
Phone
(405) 936-1092
Fax
(405) 302-5232
NPI assigned
Jun 23, 2007
Last updated
Apr 26, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 25623 OK Primary

Addresses

Primary practice location

11200 N Portland Ave
Oklahoma City, OK 73120-5045

Mailing address

11200 N Portland Ave
Oklahoma City, OK 73120-5045
Phone (405) 936-1500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110810000575 OK Practitioner - Obstetrics/Gynecology 5890964795 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Oklahoma College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oklahoma City Gynecology and Obstetrics, LLCGroup PAC ID 4284684606, 22 clinicians

Practice addresses (Care Compare)

11200 N Portland Ave
Oklahoma City, OK 73120-5045
Phone (405) 936-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25623OKMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oklahoma City Gynecology and Obstetrics, LLC Obstetrics & Gynecology CurrentSince Aug 24, 2013 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Lakeside Women's Hospital, LLC Past Accepting new patients

Locations

11200 N Portland Ave
Oklahoma City, OK 73120
Phone (405) 936-1000

11200 N Portland Ave
Fl 2
Oklahoma City, OK 73120
Phone (405) 936-1000

Interoperability endpoints

  • Direct secure messaging: daniel.n.fong.4@3062.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lakeside Women's HospitalOklahoma City, OK, CCN 370199 Hospital Contracted Managing Employee
Operational/Managerial Control		 Jul 1, 2016
Jul 1, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1182556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335398400000",
    "number": "1124224431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11200 N PORTLAND AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731205045",
            "telephone_number": "405-936-1500",
            "fax_number": "405-302-5232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 N PORTLAND AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731205045",
            "telephone_number": "405-936-1092",
            "fax_number": "405-302-5232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONG",
        "first_name": "DANIEL",
        "middle_name": "NELSON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-23",
        "last_updated": "2012-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OK",
            "license": "25623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.