Premal Khetia, MD

Primary specialty

Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X

License

23518 Issued in OK

Practice address

1023 E Cherry St
Suite B
Cushing, OK 74023-4105

Phone

(918) 225-1165

Fax

(918) 225-1953

NPI assigned

Jul 10, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• FHIR API: https://epicproxy.ardenthealth.com/fhir/UPC/api/FHIR/R4

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.

• Ahs Oklahoma Physician Group LLC

  dba Utica Park Clinic

  • Family Medicine Physician
  • Tulsa, OK
  • NPI 1235182775
  NPD (past)
• Britton Vision Associates Inc

  dba BVA Advanced Eyecare and Retina Vitreous Affiliates

  • Ophthalmology Physician
  • Edmond, OK
  • NPI 1427051408
  NPD (past)
• Saints Medical Group, LLC

  • Internal Medicine Physician
  • Shawnee, OK
  • NPI 1881648285
  NPD (past)

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285667295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 S UTICA AVE",
            "address_2": "SUITE 110",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044000",
            "telephone_number": "918-579-3825",
            "fax_number": "918-579-1262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 E CHERRY ST",
            "address_2": "SUITE B",
            "city": "CUSHING",
            "state": "OK",
            "postal_code": "740234105",
            "telephone_number": "918-225-1165",
            "fax_number": "918-225-1953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHETIA",
        "first_name": "PREMAL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "OK",
            "license": "23518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Rotz Jackson, M.S.OTR/L
• Bethaney Buddilyn Jenkins, ARNP
• Joanne Kaplan, L.C.S.W.
• Cheryl Kelly, P.T.
• Ken's Healthmart LLC (Kens Healthmart Pharmacy LLC)
• Sterling Elizabeth Koehn, DPT
• Peter Lafon, DO
• Sarah Laird, APRN-CNP
• Rod Lancaster, PHARM.D.
• Caleb Lanker

• Facial Plastic Surgery Physician in Cushing, OK
• Providers in Cushing, OK by specialty
• Facial Plastic Surgery Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.