Timothy Bushyhead
Individual provider Active NPI Family Medicine Physician · Skiatook, OK
NPI 1154718807 · NPPES record last updated Sep 5, 2018
Key facts
- NPI
- 1154718807
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 5953 (OK)
- Practice address
- 1501 W Rogers Blvd
Skiatook, OK 74070 - Phone
- (918) 396-4122
- Fax
- (918) 403-6301
- NPI assigned
- Apr 21, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 11
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Ohio State University College of Medicine, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- St. John Physicians, Inc.
Omni Medical Group Inc
Practice addresses (Care Compare)
112 N 5TH St
Barnsdall, OK 74002-6616
Phone (918) 847-2558
1705 E 19TH St
Tulsa, OK 74104-5410
1923 S Utica Ave
Tulsa, OK 74104-6520
Phone (918) 744-2967
Hospital & facility affiliations
- Ascension at Home
- Angels Care Home Health of East Oklahoma
- Enhabit Home Health of Northeast Oklahoma
- Ascension at Home - Tulsa
- Vitalcaring Group
- St John Owasso
- Ascension St John Jane Phillips
- Ascension St John Medical Center
- Ascension St John Broken Arrow
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
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 |
|---|---|---|---|---|
| I20180926000547 | OK | Practitioner - Family Practice | 8123379419 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5953 | OK | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. John Physicians, Inc | Current |
Accepting new patients | |
| Omni Medical Group Inc | Family Medicine | Current |
Accepting new patients |
| St. John Physicians, Inc. | Family Medicine | Current |
Accepting new patients |
| Owasso Medical Facility, Inc | Past | Accepting new patients | |
| St John Medical Center Inc | Past | Accepting new patients | |
| Jane Phillips Memorial Medical Center, Inc. | Past | Accepting new patients |
Locations
1501 W Rogers Blvd
Skiatook, OK 74070
Phone (918) 396-4122
1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345
1725 E 19th St
Ste 500
Tulsa, OK 74104
Phone (918) 403-7089
1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585
Interoperability endpoints
- tbushyhead715575@directa.mercy.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5953 | OK | Yes |
Addresses
Primary practice location
1501 W Rogers Blvd
Skiatook, OK 74070
Mailing address
1501 W Rogers Blvd
Skiatook, OK 74070-3924
Phone (918) 396-4122
Other providers in Skiatook, OK
- Alisha Bauchmoyer
- Bethany Bersche
- Kasey Booth
- Brett Enyart, OD, PLLC
- Melissa Byrd Briggs
- Scott Michael Carlson
- Alicia G Carner
- Hanna Evaline Chomosh
- Ciec Investments LLC
- City of Skiatook
All providers in Skiatook, 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 Sep 5, 2018. 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.