NPIMap

Individual provider Active NPI

Timothy Bushyhead

  • Family Medicine Physician
  • Skiatook, OK
National Provider Identifier
1154718807
Registry record updated Sep 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5953 Issued in OK
Practice address
1501 W Rogers Blvd
Skiatook, OK 74070
Phone
(918) 396-4122
Fax
(918) 403-6301
NPI assigned
Apr 21, 2015
Last updated
Sep 5, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5953 OK Primary

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

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
I20180926000547 OK Practitioner - Family Practice 8123379419 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
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.Group PAC ID 2567366495, 262 clinicians
Omni Medical Group IncGroup PAC ID 9739080490, 82 clinicians

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

Procedures performed for Medicare patients

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5953OKMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc CurrentSince Apr 28, 2022 Accepting new patients
Omni Medical Group Inc Family Medicine CurrentSince Oct 1, 2018 Accepting new patients
St. John Physicians, Inc. Family Medicine CurrentSince Apr 28, 2022 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

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

1725 E 19th St
Ste 500
Tulsa, OK 74104
Phone (918) 403-7089

1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345

Interoperability endpoints

  • Direct secure messaging: tbushyhead715575@directa.mercy.net

Organizations & group practices 6

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 11

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": "1429574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536105600000",
    "number": "1154718807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 W ROGERS BLVD",
            "city": "SKIATOOK",
            "state": "OK",
            "postal_code": "740703924",
            "telephone_number": "918-396-4122",
            "fax_number": "918-403-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 W ROGERS BLVD",
            "city": "SKIATOOK",
            "state": "OK",
            "postal_code": "74070",
            "telephone_number": "918-396-4122",
            "fax_number": "918-403-6301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSHYHEAD",
        "first_name": "TIMOTHY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-21",
        "last_updated": "2018-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "5953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Skiatook, OK

Sources for this page

Verify at the official NPI Registry.