Active NPI
Sheryl Evone Ghan, D.O.
- Pediatrics Physician
- Sallisaw, OK
National Provider Identifier
1184675464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 3197
- Practice address
- 301 J T Stites Blvd
Sallisaw, OK 74955-9302 - Phone
- (918) 775-9150
- NPI assigned
- May 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | E0744 | AR | |
| Pediatrics Physician | 208000000X | 3197 | OK | Primary |
Addresses
Primary practice location
301 J T Stites Blvd
Sallisaw, OK 74955-9302
Mailing address
5831 Euper LN
Fort Smith, AR 72903-3239
Phone (479) 629-6125
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 129484001 | Medicaid | AR | |
| 8ED012 | Other | MCB-SALLISAW | |
| 1203197 | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E0744 | AR | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cherokee Nation | Past | Accepting new patients |
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/2d405cde-1d8b-4a50-adff-ca7776cd856e/
Organizations & group practices 1
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.
-
- Multi-Specialty Clinic/Center
- Tahlequah, OK
- NPI 1093722324
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210896000000",
"number": "1184675464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5831 EUPER LN",
"city": "FORT SMITH",
"state": "AR",
"postal_code": "729033239",
"telephone_number": "479-629-6125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 J T STITES BLVD",
"city": "SALLISAW",
"state": "OK",
"postal_code": "749559302",
"telephone_number": "918-775-9150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHAN",
"first_name": "SHERYL",
"middle_name": "EVONE",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-12",
"last_updated": "2008-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AR",
"license": "E0744",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OK",
"license": "3197",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "129484001",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCB-SALLISAW",
"identifier": "8ED012",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1203197",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sallisaw, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.