Addison Roark, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5471 Issued in OK

Practice address

12902 E 51St St Ste 3
Tulsa, OK 74134-6712

Phone

(918) 994-3482

NPI assigned

Feb 22, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medwise LLCGroup PAC ID 8820410970, 33 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: addison.roark.1@21352.direct.athenahealth.com

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.

• Medwise LLC

  • Urgent Care Clinic/Center
  • Coweta, OK
  • NPI 1629604434
  Medicare reassignment Care Compare group NPD
• Medwise LLC

  • Durable Medical Equipment & Medical Supplies
  • Tulsa, OK
  • NPI 1407656572
  NPD

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

{
    "created_epoch": "1740182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740182400000",
    "number": "1225834922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4209 N REDBUD PL",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740120453",
            "telephone_number": "918-978-8367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12902 E 51ST ST STE 3",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741346712",
            "telephone_number": "918-994-3482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROARK",
        "first_name": "ADDISON",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-22",
        "last_updated": "2025-02-22",
        "certification_date": "2025-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "5471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rmo - Tulsa, PLLC
• Natalie Roach, BSN, RN, IBCLC
• Roadhouse Chiropractic LLC
• Brian Roadhouse, D.C.
• Susan Abigail Roads
• Robn Ranier Roark
• Claire Amelia Roarty, PA-C
• Watona Lee Robards, RN
• Cheri Lynn Robbins
• Cheryl Lynn Robbins, MSN, RN

• Physician Assistant in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.