Individual provider Active NPI

Theodora Violet Bekederemo, FNP

  • Family Nurse Practitioner
  • Oklahoma City, OK
National Provider Identifier
1205667672
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
217466 Issued in OK
Practice address
825 NE 10TH St
Oklahoma City, OK 73104-5417
Phone
(405) 271-4700
Fax
(405) 271-3727
NPI assigned
Aug 8, 2024
Last updated
Oct 31, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 217466 OK Primary

Addresses

Primary practice location

825 NE 10TH St
Oklahoma City, OK 73104-5417

Mailing address

5204 N Linn Ave
Oklahoma City, OK 73112-8029
Phone (405) 719-7909

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241018001442 OK Practitioner - Nurse Practitioner 7012449754 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ou Health Partners IncGroup PAC ID 5991105876, 1,167 clinicians

Practice addresses (Care Compare)

825 NE 10TH St
Oklahoma City, OK 73104-5417
Phone (405) 271-4700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
217466OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ou Health Partners, Inc CurrentSince Sep 1, 2024 Accepting new patients
Ou Health Partners, Inc CurrentSince Sep 1, 2024 Accepting new patients
Ou Medicine Inc. Past Accepting new patients

Locations

825 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-4864

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

Organizations & group practices 3

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 1

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": "1723075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1205667672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5204 N LINN AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731128029",
            "telephone_number": "405-719-7909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 NE 10TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045417",
            "telephone_number": "405-271-4700",
            "fax_number": "405-271-3727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEKEDEREMO",
        "first_name": "THEODORA",
        "middle_name": "VIOLET",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-08",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "217466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.