Northside Family Practice PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

NORTHSIDE FAMILY PRACTICE PLLC

Practice address

3606 N Martin Luther King Jr Blvd
Tulsa, OK 74106-6447

Phone

(918) 794-3536

Fax

(918) 794-7784

NPI assigned

Nov 18, 2011

Organization subpart

No

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

Authorized official

Name

Prakash GeorgeNPI 1053419697

Title

Cfo

Phone

(918) 704-9408

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ulysses S Bowler Jr., MD

  • Internal Medicine Physician
  • Fort Defiance, AZ
  • NPI 1942290788

  OK

  Medicare reassignment
• Prakash George, PT

  • Physical Therapist
  • Tulsa, OK
  • NPI 1053419697
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740355200000",
    "number": "1205103231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3606 N MARTIN LUTHER KING JR BLVD",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741066447",
            "telephone_number": "918-794-3536",
            "fax_number": "918-794-7784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3606 N MARTIN LUTHER KING JR BLVD",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741066447",
            "telephone_number": "918-794-3536",
            "fax_number": "918-794-7784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE FAMILY PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-18",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "PRAKASH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "918-704-9408"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northeastern Retina, P.C.
• Northern Neuromonitoring PLLC
• Northland Hearing Center, Inc.
• Northland Hearing Centers, Inc.
• Joshua Richard Northrup
• Northtulsa Counseling Services, LLC
• Daisha Norton
• Jamie Anne Norton, BS
• Michael Lance Norton, CRNA
• Rebecca S Norton, LMFT, LADC, LPC

• Internal Medicine Physician in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Internal Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.