Individual provider Active NPI

John Dale Grizzle II, M.D.

  • Family Medicine Physician
  • Oklahoma City, OK
National Provider Identifier
1255396073
Registry record updated Oct 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20170 Issued in OK
Practice address
15800 S Western Ave
Oklahoma City, OK 73170-9393
Phone
(405) 793-1300
Fax
(405) 805-6611
NPI assigned
Apr 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20170 OK Primary
Emergency Medicine Physician 207P00000X 20170 OK
Addiction Medicine (Family Medicine) Physician 207QA0401X 20170 OK

Addresses

Primary practice location

15800 S Western Ave
Oklahoma City, OK 73170-9393

Mailing address

15800 S Western Ave
Oklahoma City, OK 73170-9393
Phone (405) 793-1300

Other identifiers 6

IdentifierTypeStateIssuer
731381689GRIOtherOKPREMIERE
080136148OtherOKRAILROAD
100113130CMedicaidOK
244431002OtherOKMEDICARE ID
20170OtherOKLICENSE
25263OtherOKOBNDD

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
I20041105000673 OK Practitioner - Family PracticePractitioner - Addiction Medicine 5890758312 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Addiction Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

15800 S Western Ave
Oklahoma City, OK 73170-9393
Phone (405) 793-1300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20170OKMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Kingfisher, Inc CurrentSince Nov 20, 2017 Accepting new patients
Consulting Medical, PLLC Family Medicine CurrentSince Dec 22, 2019 Accepting new patients
Oklahoma Emergency Physician Partners PLLC Emergency Medicine Current Accepting new patients
Mercy Hospital Logan County Inc CurrentSince Nov 20, 2017 Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

1800 W University Blvd
Durant, OK 74701
Phone (580) 924-3080

200 S Academy Rd
Guthrie, OK 73044
Phone (405) 260-4165

1000 Hospital Dr
Kingfisher, OK 73750
Phone (405) 375-3141

15800 S Western Ave
#A
Oklahoma City, OK 73170

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

13654 S Western Ave
Oklahoma City, OK 73170
Phone (405) 692-7756

15800 S Western Ave
Oklahoma City, OK 73170
Phone (405) 793-1300

520 S Mustang Rd
Ste V
Yukon, OK 73099
Phone (405) 936-5905

Interoperability endpoints

  • Direct secure messaging: jgrizzle995@directa.mercy.net

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760486400000",
    "number": "1255396073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15800 S WESTERN AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731709393",
            "telephone_number": "405-793-1300",
            "fax_number": "405-805-6611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15800 S WESTERN AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731709393",
            "telephone_number": "405-793-1300",
            "fax_number": "405-805-6611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIZZLE",
        "first_name": "JOHN",
        "middle_name": "DALE",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "20170",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "20170",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "OK",
            "license": "20170",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMIERE",
            "identifier": "731381689GRI",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "080136148",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100113130C",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "244431002",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "20170",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OBNDD",
            "identifier": "25263",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.