Active NPI
Ben Imagiedouglas
- Counselor
- Oklahoma City, OK
National Provider Identifier
1255729687
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 101Y00000X
- Practice address
- 6803 S Western Ave
Suite 404
Oklahoma City, OK 73139-1808 - Phone
- (405) 420-4840
- Fax
- (405) 286-3060
- NPI assigned
- Jan 8, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Counselor | 101Y00000X | 101Y00000X | OK | Primary |
Addresses
Primary practice location
6803 S Western Ave
Suite 404
Oklahoma City, OK 73139-1808
Mailing address
PO Box 75194
Oklahoma City, OK 73147-0194
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101Y00000X | OK | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420675200000",
"number": "1255729687",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 75194",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731470194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6803 S WESTERN AVE",
"address_2": "SUITE 404",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731391808",
"telephone_number": "405-420-4840",
"fax_number": "405-286-3060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMAGIEDOUGLAS",
"first_name": "BEN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-01-08",
"last_updated": "2015-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OK",
"license": "101Y00000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.