Individual provider Active NPI

John Wesley Mooring, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Ada, OK
National Provider Identifier
1174734495
Registry record updated Nov 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
29705 Issued in OK
Practice address
421 N Monte Vista St
Ada, OK 74820-4609
Phone
(580) 332-9595
Fax
(580) 332-4921
NPI assigned
May 25, 2007
Last updated
Nov 21, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X LP02650 RI
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 29705 OK Primary

Addresses

Primary practice location

421 N Monte Vista St
Ada, OK 74820-4609

Mailing address

421 N Monte Vista St
Ada, OK 74820-4609
Phone (580) 332-9595

Other identifiers 1

IdentifierTypeStateIssuer
50997MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20130726000715 OK Practitioner - Pathology 9830330216 Reassigns benefits to 1 organization
I20131030000671 TX Practitioner - Pathology 9830330216 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Texas Medical School at San Antonio, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Oklahoma Pathology Assoc IncGroup PAC ID 9739162694, 2 clinicians

Practice addresses (Care Compare)

1921 Stonecipher Dr
Ada, OK 74820-3439
Phone (580) 436-3980

421 N Monte Vista St
Ada, OK 74820-4609
Phone (580) 332-9599

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29705OKMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cherokee Nation CurrentSince Aug 4, 2013 Accepting new patients
Chickasaw Nation Division of Health Current Accepting new patients
Cherokee Nation CurrentSince Aug 4, 2013 Accepting new patients
Anatomical Pathology Associates, Inc. Anatomic Pathology & Clinical Pathology Current Accepting new patients
Southern Oklahoma Pathology Assoc., Inc. Anatomic Pathology & Clinical Pathology CurrentSince Jul 1, 2015 Accepting new patients
Cherokee Nation Current Accepting new patients
Chickasaw Nation Division of Health Chickasaw Nation Medical Center CurrentSince Jul 1, 2015 Accepting new patients
Cherokee Nation Current Accepting new patients
Chickasaw Nation Division of Health CurrentSince Jul 1, 2015 Accepting new patients

Locations

1921 Stonecipher Dr
Ada, OK 74820
Phone (580) 421-4570

421 N Monte Vista St
Ada, OK 74820
Phone (580) 332-9595

430 N Monte Vista St
Ada, OK 74820
Phone (580) 226-1251

2510 Chickasaw Blvd
Ardmore, OK 73401
Phone (580) 226-8181

501 E 5th St
Bartlesville, OK 74003
Phone (918) 336-0823

859 E Melton Dr
Jay, OK 74346
Phone (918) 253-4271

1 E Clark Bass Blvd
McAlester, OK 74501
Phone (918) 421-6941

1001 S 41st St E
#3
Muskogee, OK 74403
Phone (918) 687-0201

1020 Lenape Dr
Nowata, OK 74048
Phone (918) 273-0192

1438 Hardcastle Blvd
Purcell, OK 73080
Phone (405) 527-4700

900 N Owen Walters Blvd
Salina, OK 74365
Phone (918) 434-8500

100 S Bliss Ave
Tahlequah, OK 74464
Phone (918) 458-3100

817 E 6th St
Tishomingo, OK 73460
Phone (580) 371-2392

Dept 2269
Tulsa, OK 74182

27371 S 4410 Rd
Vinita, OK 74301
Phone (918) 256-4800

Organizations & group practices 9

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 10

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": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574294400000",
    "number": "1174734495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 N MONTE VISTA ST",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748204609",
            "telephone_number": "580-332-9595",
            "fax_number": "580-332-4921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 N MONTE VISTA ST",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748204609",
            "telephone_number": "580-332-9595",
            "fax_number": "580-332-4921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORING",
        "first_name": "JOHN",
        "middle_name": "WESLEY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2019-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "RI",
            "license": "LP02650",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OK",
            "license": "29705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50997",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ada, OK

Sources for this page

Verify at the official NPI Registry.