Individual provider Active NPI

Jennifer L Hanslick, MD

  • Neonatal-Perinatal Medicine Physician
  • Tulsa, OK
National Provider Identifier
1285809632
Registry record updated Feb 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
49529 Issued in CO
Practice address
1120 S Utica Ave
Suite 2123
Tulsa, OK 74104-4012
Phone
(918) 579-5402
Fax
(918) 579-5404
NPI assigned
Apr 28, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2020

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2009012792 MO
Neonatal-Perinatal Medicine Physician 2080N0001X MD177451 OR
Neonatal-Perinatal Medicine Physician 2080N0001X 2009012792 MO
Neonatal-Perinatal Medicine Physician 2080N0001X 32635 OK
Neonatal-Perinatal Medicine Physician 2080N0001X 49529 CO Primary

Addresses

Primary practice location

1120 S Utica Ave
Suite 2123
Tulsa, OK 74104-4012

Mailing address

1120 S Utica Ave
Suite 2123
Tulsa, OK 74104
Phone (918) 579-5402

Other practice location 1

2500 NE Neff Rd
Bend, OR 97701-6015
Phone (541) 382-4321

Other identifiers 2

IdentifierTypeStateIssuer
200673240AMedicaidOK
50271768MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, NV2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090618000359 OR Practitioner - Pediatric Medicine 7416007174 Reassigns benefits to 1 organization
I20200219000779 NV Practitioner - Pediatric Medicine 7416007174 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
49529COMDNeonatal-Perinatal Medicine Physician
32635OKMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Charles Health System, Inc. Current Accepting new patients
St. Charles Health System, Inc. CurrentSince Feb 1, 2020 Accepting new patients
Pokroy Medical Group of Nevada, LTD. Pediatrics CurrentSince Dec 21, 2019 Accepting new patients
St. Charles Health System, Inc. CurrentSince Feb 1, 2020 Accepting new patients
Renown Regional Medical Center Past Accepting new patients

Locations

770 The City Dr S
Ste 4000
Orange, CA 92868
Phone (800) 463-6628

29358 Network Pl
Chicago, IL 60673

3186 S Maryland Pkwy
Las Vegas, NV 89109
Phone (702) 731-8000

1155 Mill St
Bldg 55
Reno, NV 89502

2500 NE Neff Rd
Bend, OR 97701
Phone (541) 388-4333

1253 NW Canal Blvd
Redmond, OR 97756
Phone (541) 548-8131

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582675200000",
    "number": "1285809632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 S UTICA AVE",
            "address_2": "SUITE 2123",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74104",
            "telephone_number": "918-579-5402",
            "fax_number": "918-579-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 S UTICA AVE",
            "address_2": "SUITE 2123",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044012",
            "telephone_number": "918-579-5402",
            "fax_number": "918-579-5404"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 NE Neff Rd",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977016015",
            "country_code": "US",
            "telephone_number": "541-382-4321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANSLICK",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-28",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2009012792",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "OR",
            "license": "MD177451",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "MO",
            "license": "2009012792",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "OK",
            "license": "32635",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "CO",
            "license": "49529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200673240A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50271768",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.