Individual provider Active NPI

Marielle Ysabel Elder, PA-C

  • Physician Assistant
  • Oklahoma City, OK
National Provider Identifier
1225634058
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4434 Issued in OK
Practice address
3366 NW Expressway Ste 800
Oklahoma City, OK 73112-4458
Phone
(405) 713-9935
Fax
(405) 713-9936
NPI assigned
Dec 7, 2020
Last updated
Nov 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 4434 OK Primary

Addresses

Primary practice location

3366 NW Expressway Ste 800
Oklahoma City, OK 73112-4458

Mailing address

3001 Quail Springs Pkwy FL 5
Oklahoma City, OK 73134-2640
Phone (405) 713-9935

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
I20210107001025 OK Practitioner - Physician Assistant 2264845452 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integris Ambulatory Care CorporationGroup PAC ID 2365408465, 687 clinicians

Practice addresses (Care Compare)

3400 NW Expressway
Suite 500
Oklahoma City, OK 73112-4492
Phone (405) 945-4589

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ou Health Partners, Inc CurrentSince Sep 9, 2021 Accepting new patients
Integris Ambulatory Care C Orporation Past Accepting new patients

Locations

700 NE 13th St
Oklahoma City, OK 73104
Phone (405) 271-3667

711 Stanton L Young Blvd
Ste 524
Oklahoma City, OK 73104
Phone (405) 271-3900

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

Organizations & group practices 4

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 4

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": "1607299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1225634058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 QUAIL SPRINGS PKWY FL 5",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731342640",
            "telephone_number": "405-713-9935",
            "fax_number": "405-713-9936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3366 NW EXPRESSWAY STE 800",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731124458",
            "telephone_number": "405-713-9935",
            "fax_number": "405-713-9936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELDER",
        "first_name": "MARIELLE",
        "middle_name": "YSABEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-07",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "4434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.