Kevin Anderson, D.O.
Individual provider Active NPI Family Medicine Physician · Chickasha, OK
NPI 1154655157 · NPPES record last updated Aug 16, 2016
Key facts
- NPI
- 1154655157
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 4878 (OK)
- Practice address
- 2100 W Iowa Ave
Suite a
Chickasha, OK 73018-2736 - Phone
- (405) 224-2100
- Fax
- (405) 779-2855
- NPI assigned
- Sep 23, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Grady Memorial Hospital
Practice addresses (Care Compare)
2100 S Iowa Ave
Chickasha, OK 73018-2736
Phone (405) 224-2100
2100 W Iowa Ave
Suite a
Chickasha, OK 73018-2736
Phone (405) 224-2100
2116 W Iowa Ave
Chickasha, OK 73018-2736
Phone (405) 224-2100
2220 W Iowa Ave
Chickasha, OK 73018-2738
Phone (405) 224-2300
Hospital & facility affiliations
- Lifeline Home Health Care, Inc
- Elara Caring IV
- Enhabit Home Health of Western Oklahoma
- Traditions Health of Western Oklahoma
- Grady Memorial Hospital
- O U Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.91 of 100
- Quality
- 76.55
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- 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 |
|---|---|---|---|---|
| I20120806000855 | OK | Practitioner - Family Practice | 9234385386 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4878 | OK | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grady Memorial Hospital | Current | Accepting new patients | |
| Grady Memorial Hospital | Current | Accepting new patients | |
| Grady Memorial Hospital | Family Medicine | Current |
Accepting new patients |
| Grady Memorial Hospital | Current | Accepting new patients | |
| Grady Memorial Hospital | Family Medicine | Current |
Accepting new patients |
| Summit Medical Center | Past | Accepting new patients |
Locations
2220 W Iowa Ave
Chickasha, OK 73018
Phone (405) 224-2100
2100 W Iowa Ave
Ste A
Chickasha, OK 73018
Phone (405) 224-2100
2100 W Iowa Ave
Chickasha, OK 73018
Phone (405) 224-2100
Interoperability endpoints
- kanderson@direct.gradymem.org
- kanderson@gmh.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4878 | OK | Yes |
Addresses
Primary practice location
2100 W Iowa Ave
Suite a
Chickasha, OK 73018-2736
Mailing address
2100 W Iowa Ave
Suite a
Chickasha, OK 73018-2736
Phone (405) 224-2100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200312900B | Medicaid | OK |
Other providers in Chickasha, OK
- A Premier Senior Home Care Acquisitions, LLC
- A Premier Senior Home Care Acquisitions, LLC
- Brittany Leah Abshire
- Catina Louise Anderson
- Eric Joseph Anderson
- Lauren Harley Antrim
- Amberly Arellano
- Erin Baylee Armstrong
- Around the Clock Home Care
- Clyde W Ates
All providers in Chickasha, OK · Family 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 Aug 16, 2016. 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.