NPIMap

Organization Active NPI

Broken Arrow Pediatrics, LLC

  • Pediatrics Physician
  • Broken Arrow, OK
National Provider Identifier
1265879175
Registry record updated May 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
12938 Issued in OK
Legal business name
BROKEN ARROW PEDIATRICS, LLC
Practice address
1220 N Elm PL
Broken Arrow, OK 74012-1616
Phone
(918) 258-1955
NPI assigned
May 31, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2013

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

Authorized official

Name
Dr. Carl Erwin Pfanstiel, M.D.NPI 1578500385
Title
Owner
Phone
(918) 258-1955

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 12938 OK Primary

Addresses

Primary practice location

1220 N Elm PL
Broken Arrow, OK 74012-1616

Mailing address

1220 N Elm PL
Broken Arrow, OK 74012-1616
Phone (918) 258-1955

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D0720032Broken Arrow Pediatrics1220 N Elm Place, Broken Arrow, OK 74012Certificate of waiverOct 10, 2026

National Provider Directory

National Provider Directory

Locations

1220 N Elm Pl
Broken Arrow, OK 74012
Phone (918) 237-9515

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369958400000",
    "number": "1265879175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 N ELM PL",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740121616",
            "telephone_number": "918-258-1955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 N ELM PL",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740121616",
            "telephone_number": "918-258-1955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROKEN ARROW PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-31",
        "last_updated": "2013-05-31",
        "status": "A",
        "authorized_official_last_name": "PFANSTIEL",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "ERWIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-258-1955",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "12938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.