NPIMap

Organization Active NPI

Osumc Professional Services LLC

  • Sports Medicine (Family Medicine) Physician
  • Sand Springs, OK
National Provider Identifier
1154845501
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
5451 Issued in OK
Legal business name
OSUMC PROFESSIONAL SERVICES LLC
Practice address
514 Plaza CT
Sand Springs, OK 74063-7915
Phone
(918) 215-5100
Fax
(918) 215-5105
NPI assigned
Jul 27, 2017
Organization subpart
Yes
Parent organization
OSUMC PROFESSIONAL SERVICES LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Samantha Overfield
Title
Credentialing Administrator
Phone
(918) 561-5714

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X 5451 OK Primary

Addresses

Primary practice location

514 Plaza CT
Sand Springs, OK 74063-7915

Mailing address

514 Plaza CT
Sand Springs, OK 74063-7915
Phone (918) 215-5100

Other identifiers 3

IdentifierTypeStateIssuer
200308130AMedicaidOK
OKA101159OtherOKMEDICARE
DR7481OtherOKRR MEDICARE PTAN

Other names 1

  • OSU Medical Group Sand Springs Primary Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Osumc Professional3 organizations share this tax ID, including this one
Part of
Osumc Professional

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

514 Plaza Ct
Sand Springs, OK 74063
Phone (918) 215-5100

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1501113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1154845501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 PLAZA CT",
            "city": "SAND SPRINGS",
            "state": "OK",
            "postal_code": "740637915",
            "telephone_number": "918-215-5100",
            "fax_number": "918-215-5105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 PLAZA CT",
            "city": "SAND SPRINGS",
            "state": "OK",
            "postal_code": "740637915",
            "telephone_number": "918-215-5100",
            "fax_number": "918-215-5105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OSUMC PROFESSIONAL SERVICES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OSUMC PROFESSIONAL SERVICES LLC",
        "enumeration_date": "2017-07-27",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "OVERFIELD",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "CREDENTIALING ADMINISTRATOR",
        "authorized_official_telephone_number": "918-561-5714"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "OK",
            "license": "5451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200308130A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "OKA101159",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PTAN",
            "identifier": "DR7481",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OSU Medical Group Sand Springs Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sand Springs, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.