NPIMap

Individual provider Active NPI

Jeffrey B Cruzan, M.D.

  • Family Medicine Physician
  • Oklahoma City, OK
National Provider Identifier
1184661977
Registry record updated Mar 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
15732 Issued in OK
Practice address
5915 W Memorial Rd
Suite 300
Oklahoma City, OK 73142-2021
Phone
(405) 773-6470
Fax
(405) 773-6463
NPI assigned
Jun 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 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 15732 OK Primary

Addresses

Primary practice location

5915 W Memorial Rd
Suite 300
Oklahoma City, OK 73142-2021

Mailing address

5300 N Independence Ave
Suite 280
Oklahoma City, OK 73112-5556
Phone (405) 773-6470

Other identifiers 1

IdentifierTypeStateIssuer
100258060AMedicaidOK

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
I20041216000520 OK Practitioner - Family Practice 1759348279 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Oklahoma College of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integris Ambulatory Care CorporationGroup PAC ID 2365408465, 687 clinicians

Practice addresses (Care Compare)

5915 W Memorial Rd
300 Integris Fam Care Mem W
Oklahoma City, OK 73142-2022
Phone (405) 773-6470

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15732OKMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Integris Ambulatory Care Corporation Family Medicine CurrentSince Jan 1, 2005 Accepting new patients
National Family Medical Associates, LLC Family Medicine PastSince Feb 1, 2023 Accepting new patients
Summit Medical Center Past Accepting new patients
Centennial Health, PC Family Medicine PastSince May 1, 1992 Accepting new patients
Integris Ambulatory Care C Orporation Family Medicine Past Accepting new patients

Locations

5300 N Independence Ave
Ste 280
Oklahoma City, OK 73112
Phone (405) 552-0155

6601 W Hefner Rd
Oklahoma City, OK 73162
Phone (405) 720-3108

5915 W Memorial Rd
Ste 300
Oklahoma City, OK 73142
Phone (405) 773-6470

3400 NW Expressway
Ste 500
Oklahoma City, OK 73112
Phone (405) 945-4589

Interoperability endpoints

  • Direct secure messaging: jcruzan9376@direct.integrisok.com

Organizations & group practices 5

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.

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": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521072000000",
    "number": "1184661977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 N INDEPENDENCE AVE",
            "address_2": "SUITE 280",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731125556",
            "telephone_number": "405-773-6470",
            "fax_number": "405-773-6463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5915 W MEMORIAL RD",
            "address_2": "SUITE 300",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731422021",
            "telephone_number": "405-773-6470",
            "fax_number": "405-773-6463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUZAN",
        "first_name": "JEFFREY",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2018-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "15732",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100258060A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.