Active NPI
Jack Robin Snedden III, M.D.
- Hospitalist Physician
- Owasso, OK
National Provider Identifier
1215908041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospitalist Physician
- License
- 21312
- Practice address
- 10502 North 110TH East Avenue
Owasso, OK 74055-6655 - Phone
- (918) 376-8590
- Fax
- (918) 376-8549
- NPI assigned
- Jan 30, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 21312 | OK | |
| Hospitalist Physician | 208M00000X | 21312 | OK | Primary |
Addresses
Primary practice location
10502 North 110TH East Avenue
Owasso, OK 74055-6655
Mailing address
10502 N 110TH East Ave
Owasso, OK 74055-6655
Phone (918) 376-8590
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100120000A | 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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21312 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southcrest Emergency Physicians PC | Past | Accepting new patients | |
| Jane Phillips Nowata Hospital Inc | Past | Accepting new patients |
Interoperability endpoints
- jsnedden112842@ahs.direct-ci.com
Organizations & group practices 2
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.
-
dba Ascension Jane Phillips Nowata
- General Acute Care Hospital
- Nowata, OK
- NPI 1548247489
-
- Emergency Medical Services (Emergency Medicine) Physician
- Tulsa, OK
- NPI 1205816048
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399334400000",
"number": "1215908041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10502 N 110TH EAST AVE",
"city": "OWASSO",
"state": "OK",
"postal_code": "740556655",
"telephone_number": "918-376-8590",
"fax_number": "918-376-8549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10502 NORTH 110TH EAST AVENUE",
"city": "OWASSO",
"state": "OK",
"postal_code": "740556655",
"telephone_number": "918-376-8590",
"fax_number": "918-376-8549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SNEDDEN",
"first_name": "JACK",
"middle_name": "ROBIN",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-30",
"last_updated": "2014-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "21312",
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "OK",
"license": "21312",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100120000A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Owasso, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.