NPIMap

Individual provider Active NPI

Jeanne Alice Roder, P.A.-C

  • Medical Physician Assistant
  • Oklahoma City, OK
National Provider Identifier
1285691287
Registry record updated Aug 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1115 Issued in OK
Practice address
525 SW 80TH St
Suite 200
Oklahoma City, OK 73139
Phone
(405) 631-0481
Fax
(405) 631-9025
NPI assigned
Apr 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 1115 OK Primary

Addresses

Primary practice location

525 SW 80TH St
Suite 200
Oklahoma City, OK 73139

Mailing address

525 SW 80TH St
Suite 200
Oklahoma City, OK 73139
Phone (405) 631-0481

Other identifiers 2

IdentifierTypeStateIssuer
100191990AMedicaidOK
970018299OtherOKRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100427000798 OK Practitioner - Physician Assistant 6103953989

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Oklahoma College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

8100 S Walker Ave
Building a Suite 230
Oklahoma City, OK 73139-9405

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.8 of 100Reported as group
Quality
89.59
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1115OKMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Nick Knutson MD, a Professional Corporation Past Accepting new patients

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566345600000",
    "number": "1285691287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 SW 80TH ST",
            "address_2": "SUITE 200",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73139",
            "telephone_number": "405-631-0481",
            "fax_number": "405-631-9025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 SW 80TH ST",
            "address_2": "SUITE 200",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73139",
            "telephone_number": "405-631-0481",
            "fax_number": "405-631-9025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODER",
        "first_name": "JEANNE",
        "middle_name": "ALICE",
        "name_prefix": "Ms.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-26",
        "last_updated": "2019-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "1115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100191990A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970018299",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.