Active NPI
Tommie Gay Stanberry, PA-C
- Medical Physician Assistant
- Tishomingo, OK
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 1655
- Practice address
- 610 E 24TH St
Tishomingo, OK 73460-3245 - Phone
- (580) 371-2343
- Fax
- (580) 371-2451
- NPI assigned
- Aug 6, 2007
- Last updated
- Sep 2, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 1655 | OK | Primary |
Addresses
Primary practice location
610 E 24TH St
Tishomingo, OK 73460-3245
Mailing address
610 E 24TH St
Tishomingo, OK 73460-3245
Phone (580) 371-2343
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1655 | Other | OK | LICENSE NUMBER PA-C |
| 200128520A | Medicaid | OK |
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: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- University of North Dakota School of Medicine, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4494 S Forrest Hill Rd
Atoka, OK 74525-4633
6 N Covington St
Coalgate, OK 74538-2002
Phone 5809272327245
PO Box
Suite 326
Coalgate, OK 74538
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1655 | OK | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coal County General Hospital | Current | Accepting new patients | |
| Coal County General Hospital | Current | Accepting new patients | |
| Coal County General Hospital | Past | Accepting new patients | |
| Helton Rural Health Clinic | Past | Accepting new patients |
Locations
1668 W Liberty Rd
Atoka, OK 74525
Phone (580) 326-6423
108 W Ohio Ave
Coalgate, OK 74538
Phone (580) 513-0743
6 N Covington St
Coalgate, OK 74538
Phone (580) 927-2327
1011 N Hinckley St
Holdenville, OK 74848
Phone (405) 592-3500
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Mary Hurley Hospital
- Critical Access Hospital Clinic/Center
- Coalgate, OK
- NPI 1750459756
-
dba Eastern Oklahoma Health Clinic of Atoka
- Family Medicine Physician
- Atoka, OK
- NPI 1639877871
-
dba Mary Hurley Hospital
- Critical Access Hospital
- Coalgate, OK
- NPI 1629077227
-
- Family Medicine Physician
- Coalgate, OK
- NPI 1720265945
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba TenderCare Home Health
- Home Health Agency
- Coalgate, OK
- NPI 1104257534
-
dba Atoka County Medical Center
- Critical Access Hospital
- Atoka, OK
- NPI 1508896499
-
dba Mary Hurley Hospital
- Critical Access Hospital
- Coalgate, OK
- NPI 1629077227
-
dba Mays Housecall Home Health of Durant
- Home Health Agency
- Durant, OK
- NPI 1720480932
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283385600000",
"number": "1194916015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 E 24TH ST",
"city": "TISHOMINGO",
"state": "OK",
"postal_code": "734603245",
"telephone_number": "580-371-2343",
"fax_number": "580-371-2451"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 E 24TH ST",
"city": "TISHOMINGO",
"state": "OK",
"postal_code": "734603245",
"telephone_number": "580-371-2343",
"fax_number": "580-371-2451"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANBERRY",
"first_name": "TOMMIE",
"middle_name": "GAY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-06",
"last_updated": "2010-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "OK",
"license": "1655",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER PA-C",
"identifier": "1655",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200128520A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tishomingo, OK
- Southern Oklahoma Treatment Services, Inc
- Southern Oklahoma Treatment Services, Inc.
- Southern Oklahoma Treatment Services, Inc.
- Southern Oklahoma Treatment Services, Inc.
- Ashley Elizabeth Stacy, BS, BHRS
- Jennifer Nicole Standridge
- Cody Don Stephens
- Kalyn Michelle Stephens, LPC
- Ashley Nicole Stites, APRN, CNP
- Marion C Straub, BHRS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.