NPIMap

Individual provider Active NPI

Sophia Delise Hackney, PA-C

  • Physician Assistant
  • Tulsa, OK
National Provider Identifier
1265096424
Registry record updated Jun 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3052 Issued in OK
Practice address
8282 S Memorial Dr Ste 106
Tulsa, OK 74133-4311
Phone
(918) 579-4200
NPI assigned
Apr 23, 2019
Last updated
Jun 17, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2019

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 3052 OK Primary

Addresses

Primary practice location

8282 S Memorial Dr Ste 106
Tulsa, OK 74133-4311

Mailing address

12112 S 83Rd East Ave Apt 422
Bixby, OK 74008-3344
Phone (405) 308-5490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220103000206 DE Practitioner - Physician Assistant 1052648250 Reassigns benefits to 1 organization
I20231204001246 CO Practitioner - Physician Assistant 1052648250 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology and Imaging Consultants PCGroup PAC ID 1850298647, 45 clinicians

Practice addresses (Care Compare)

1400 E Boulder St
Memorial Hospital Central
Colorado Springs, CO 80909-5599
Phone (719) 365-5120

175 S Union Blvd
Colorado Springs, CO 80910-3113
Phone (719) 365-5242

4050 Briargate Pkwy
Colorado Springs, CO 80920-7815
Phone (719) 364-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.92 of 100Reported as group
Quality
100
Improvement activities
40
Cost
43.08

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3052OKMDChiropractor

Interoperability endpoints

  • Direct secure messaging: shackney265793@ahs.direct-ci.com

Organizations & group practices 2

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 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1555977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560729600000",
    "number": "1265096424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12112 S 83RD EAST AVE APT 422",
            "city": "BIXBY",
            "state": "OK",
            "postal_code": "740083344",
            "telephone_number": "405-308-5490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8282 S MEMORIAL DR STE 106",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741334311",
            "telephone_number": "918-579-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKNEY",
        "first_name": "SOPHIA",
        "middle_name": "DELISE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-23",
        "last_updated": "2019-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "3052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.