NPIMap

Individual provider Active NPI

Shivendra Bansal, M.D.

  • Family Medicine Physician
  • Shawnee, OK
National Provider Identifier
1144679952
Registry record updated Jun 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
32293 Issued in OK
Practice address
3315 Kethley Rd
Shawnee, OK 74804
Phone
(405) 273-5801
Fax
(405) 878-3794
NPI assigned
Jun 13, 2016
Last updated
Jun 4, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 32293 OK Primary

Addresses

Primary practice location

3315 Kethley Rd
Shawnee, OK 74804

Mailing address

3315 Kethley Rd
Shawnee, OK 74804-9638
Phone (405) 273-5801

Other practice location 1

900 NE 10th St
Oklahoma City, OK 73104-5420
Phone (405) 271-2230

Other practice location 2

900 NE 10th St
Oklahoma City, OK 73104-5420
Phone (405) 271-2230

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
I20190909003427 OK Practitioner - Family Practice 7416230479 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saints Medical Group, LLCGroup PAC ID 7012914898, 430 clinicians

Practice addresses (Care Compare)

2749 Progressive Dr
Edmond, OK 73034-7649
Phone (405) 772-4130

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
32293OKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saints Medical Group, LLC Family Medicine CurrentSince Apr 1, 2024 Accepting new patients
Saints Medical Group, LLC CurrentSince Apr 1, 2024 Accepting new patients
St Anthony Shawnee Hospital Inc Past Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

608 NW 9th St
Ste 2200
Oklahoma City, OK 73102
Phone (405) 231-3737

3214 Kethley Rd
Shawnee, OK 74804
Phone (405) 273-5801

3315 Kethley Rd
Shawnee, OK 74804
Phone (405) 273-5801

Interoperability endpoints

  • Direct secure messaging: sbansal329494@direct-ehr-ssmhc.com

Organizations & group practices 4

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": "1465776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559606400000",
    "number": "1144679952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3315 KETHLEY RD",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748049638",
            "telephone_number": "405-273-5801",
            "fax_number": "405-878-3794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3315 KETHLEY RD",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "74804",
            "telephone_number": "405-273-5801",
            "fax_number": "405-878-3794"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 NE 10th St",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731045420",
            "country_code": "US",
            "telephone_number": "405-271-2230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "900 NE 10th St",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731045420",
            "country_code": "US",
            "telephone_number": "405-271-2230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANSAL",
        "first_name": "SHIVENDRA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-13",
        "last_updated": "2019-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "32293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawnee, OK

Sources for this page

Verify at the official NPI Registry.