Individual provider Active NPI

Zachary Alan Fowler, D.O.

  • Family Medicine Physician
  • Tulsa, OK
National Provider Identifier
1164659983
Registry record updated Jun 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4900 Issued in OK
Practice address
1717 S Utica Ave Ste a
Tulsa, OK 74104-5346
Phone
(918) 748-7557
Fax
(918) 748-7514
NPI assigned
Jun 18, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2014

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 4900 OK Primary

Addresses

Primary practice location

1717 S Utica Ave Ste a
Tulsa, OK 74104-5346

Mailing address

1717 S Utica Ave Ste a
Tulsa, OK 74104-5346
Phone (918) 748-7557

Other identifiers 1

IdentifierTypeStateIssuer
200294460BMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20120802000724 OK Practitioner - Family Practice 9133375322 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St John Urgent Care Clinics IncGroup PAC ID 5890898084, 29 clinicians

Practice addresses (Care Compare)

1717 S Utica Ave
Suite a
Tulsa, OK 74104-5346
Phone (918) 748-1300

1910 S Falcon Ave
Claremore, OK 74019-2237
Phone (918) 343-6855

402 W Morrow Rd
Sand Springs, OK 74063-6549
Phone (918) 245-1119

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4900OKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc CurrentSince Jun 10, 2014 Accepting new patients
St. John Physicians, Inc. Family Medicine CurrentSince Jun 10, 2014 Accepting new patients
St John Urgent Care Clinics Inc CurrentSince Jun 10, 2014 Accepting new patients
Urgent Care of Green Country PLLC Past Accepting new patients

Locations

9645 Riverside Pkwy
Ste C
Tulsa, OK 74137
Phone (918) 209-5170

1717 S Utica Ave
Ste A
Tulsa, OK 74104
Phone (918) 748-1300

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

Interoperability endpoints

  • Direct secure messaging: zachary.fowler.1@19843.direct.athenahealth.com
  • Direct secure messaging: zachary.fowler.1@23846.direct.athenahealth.com
  • Direct secure messaging: zachary.fowler@direct.stjohnhealthsystem.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1245283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401926400000",
    "number": "1164659983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 S UTICA AVE STE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045346",
            "telephone_number": "918-748-7557",
            "fax_number": "918-748-7514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S UTICA AVE STE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045346",
            "telephone_number": "918-748-7557",
            "fax_number": "918-748-7514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "ZACHARY",
        "middle_name": "ALAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-18",
        "last_updated": "2014-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "4900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200294460B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.