NPIMap

Individual provider Active NPI

Kristy Petersen, MD

  • Family Medicine Physician
  • Enid, OK
National Provider Identifier
1225127798
Registry record updated Aug 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19458 Issued in OK
Practice address
3517 W Owen K Garriott Rd
Suite Four
Enid, OK 73703-4952
Phone
(580) 233-5553
NPI assigned
Oct 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 19458 OK Primary

Addresses

Primary practice location

3517 W Owen K Garriott Rd
Suite Four
Enid, OK 73703-4952

Mailing address

PO Box 3494
Enid, OK 73702-3494
Phone (580) 233-5553

Other identifiers 1

IdentifierTypeStateIssuer
100253950AMedicaidOK

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
I20100301000820 OK Practitioner - HospitalistPractitioner - Family Practice 9739269911 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Family Practice
Education
University of Oklahoma College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Apogee Medical Group Oklahoma IncGroup PAC ID 0840359394, 7 clinicians

Practice addresses (Care Compare)

305 S 5TH St
Enid, OK 73701-5832
Phone (580) 233-6100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.44 of 100Reported as group
Quality
85.31
Improvement activities
40
Cost
80.05

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Enid Clinic Inc Family Medicine CurrentSince Mar 31, 2024 Accepting new patients
Apogee Medical Group Oklahoma Inc CurrentSince Mar 1, 2013 Accepting new patients
Uhs of Oklahoma, LLC Past Accepting new patients

Locations

15059 N Scottsdale Rd
Ste 600
Scottsdale, AZ 85254
Phone (602) 778-3601

305 S 5th St
Enid, OK 73701
Phone (580) 233-6100

3201 N Van Buren St
Ste 300
Enid, OK 73703
Phone (580) 233-5553

3517 W Owen K Garriott Rd
Ste 4
Enid, OK 73703
Phone (580) 233-5553

900 17th St
Woodward, OK 73801
Phone (405) 610-4411

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250640000000",
    "number": "1225127798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3494",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737023494",
            "telephone_number": "580-233-5553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3517 W OWEN K GARRIOTT RD",
            "address_2": "SUITE FOUR",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737034952",
            "telephone_number": "580-233-5553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KRISTY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2009-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "19458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100253950A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Enid, OK

Sources for this page

Verify at the official NPI Registry.