NPIMap

Individual provider Active NPI

Andra Dale Nuzum-Keim, M.D.

  • Diagnostic Radiology Physician
  • Tulsa, OK
National Provider Identifier
1205063864
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
27297 Issued in OK
Practice address
5801 E 41St St Ste 900
Tulsa, OK 74135-5631
Phone
(918) 747-4975
Fax
(918) 743-8552
NPI assigned
Jun 22, 2009
Last updated
Jul 13, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 27297 OK
Student in an Organized Health Care Education/Training Program 390200000X
Diagnostic Radiology Physician 2085R0202X 27297 OK Primary

Addresses

Primary practice location

5801 E 41St St Ste 900
Tulsa, OK 74135-5631

Mailing address

PO Box 4930
Tulsa, OK 74159-0930
Phone (918) 747-4975

Other identifiers 1

IdentifierTypeStateIssuer
200263460AMedicaidOK

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
I20110111000966 OK Practitioner - Diagnostic RadiologyPractitioner - General Surgery 2062601750 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Oklahoma College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Concord Radiology PLLCGroup PAC ID 8628332061, 217 clinicians

Practice addresses (Care Compare)

11221 S Harvard PL
Tulsa, OK 74137-7815
Phone (888) 264-0330

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.7 of 100Reported as group
Quality
91.25
Improvement activities
40
Cost
41.71

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
27297OKMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Concord Radiology PLLC Diagnostic Radiology CurrentSince Jan 1, 2025 Accepting new patients
Coaxion PLLC Diagnostic Radiology CurrentSince Oct 13, 2025 Accepting new patients
Tulsa Radiology Associates Inc Diagnostic Radiology CurrentSince Jul 1, 2016 Accepting new patients
Oca MWC LP Past Accepting new patients
Radiology Consultants of Tulsa Inc Diagnostic Radiology Past Accepting new patients

Locations

3500 E Frank Phillips Blvd
Bartlesville, OK 74006
Phone (918) 331-1555

4111 S Darlington Ave
Ste 700
Tulsa, OK 74135
Phone (918) 743-8943

5801 E 41st St
Ste 900
Tulsa, OK 74135
Phone (918) 743-8838

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1245628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1205063864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4930",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741590930",
            "telephone_number": "918-747-4975",
            "fax_number": "918-743-8552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5801 E 41ST ST STE 900",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741355631",
            "telephone_number": "918-747-4975",
            "fax_number": "918-743-8552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUZUM-KEIM",
        "first_name": "ANDRA",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-22",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "OK",
            "license": "27297",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OK",
            "license": "27297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200263460A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.