Individual provider Active NPI

Clark R Higganbotham

  • Urology Physician
  • Tulsa, OK
National Provider Identifier
1164042560
Registry record updated Jun 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
47339 Issued in OK
Practice address
10901 E 48TH St
Tulsa, OK 74146-5830
Phone
(918) 749-8765
Fax
(918) 392-2155
NPI assigned
Apr 26, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 47339 OK Primary

Addresses

Primary practice location

10901 E 48TH St
Tulsa, OK 74146-5830

Mailing address

10901 E 48TH St
Tulsa, OK 74146-5830
Phone (918) 749-8765

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210803001615 LA Order and Referring Only - UrologyPractitioner - Urology 2264836980

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Oklahoma College of Medicine, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

10901 E 48TH St
Tulsa, OK 74146-5830

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1587859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782345600000",
    "number": "1164042560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10901 E 48TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741465830",
            "telephone_number": "918-749-8765",
            "fax_number": "918-392-2155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10901 E 48TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741465830",
            "telephone_number": "918-749-8765",
            "fax_number": "918-392-2155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIGGANBOTHAM",
        "first_name": "CLARK",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-26",
        "last_updated": "2026-06-25",
        "certification_date": "2026-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OK",
            "license": "47339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.