Individual provider Active NPI

Tate Camren Vance

  • Family Medicine Physician
  • Tulsa, OK
National Provider Identifier
1235631896
Registry record updated Oct 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
6787 Issued in OK
Practice address
2345 Southwest Blvd
Tulsa, OK 74107-2705
Phone
(918) 582-1980
NPI assigned
Feb 28, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 6787 OK Primary

Addresses

Primary practice location

2345 Southwest Blvd
Tulsa, OK 74107-2705

Mailing address

2345 Southwest Blvd
Tulsa, OK 74107-2705
Phone (918) 582-1980

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200519000609 OK Practitioner - Family Practice 4385075720 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Usacs Observation Medicine Services of Oklahoma, LLCGroup PAC ID 9931562956, 203 clinicians

Practice addresses (Care Compare)

1000 W Boise Cir
Broken Arrow, OK 74012-4900
Phone (918) 994-8000

12451 E 100TH St N
Owasso, OK 74055-4600
Phone (918) 274-5000

300 Rockefeller Dr
Muskogee, OK 74401-5075
Phone (918) 684-2101

6161 S Yale Ave
Tulsa, OK 74136-1902

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6787OKMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Medicine Physicians of Texas, PLLC Family Medicine CurrentSince Sep 4, 2023 Accepting new patients
Cleveland Area Hospital Holdings, Inc. Current Accepting new patients
Rokem, LLC CurrentSince Aug 26, 2023 Accepting new patients
Usacs Observation Medicine Services of Oklahoma, LLC CurrentSince Nov 5, 2024 Accepting new patients
St. John Broken Arrow, Inc Past Accepting new patients

Locations

1000 W Boise Cir
Broken Arrow, OK 74012
Phone (918) 994-8000

1401 W Pawnee St
Cleveland, OK 74020
Phone (918) 358-2501

300 Rockefeller Dr
Muskogee, OK 74401
Phone (918) 682-5501

1000 N Lee Ave
Oklahoma City, OK 73102
Phone (405) 272-6152

6161 S Yale Ave
Tulsa, OK 74136
Phone (918) 494-2200

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

Organizations & group practices 5

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 5

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": "1519776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634688000000",
    "number": "1235631896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 SOUTHWEST BLVD",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741072705",
            "telephone_number": "918-582-1980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2345 SOUTHWEST BLVD",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741072705",
            "telephone_number": "918-582-1980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANCE",
        "first_name": "TATE",
        "middle_name": "CAMREN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-28",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "6787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.