Individual provider Active NPI

Matthew K Loeber, APRN-CNP

  • Family Nurse Practitioner
  • Edmond, OK
National Provider Identifier
1295135341
Registry record updated Jan 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R98967 Issued in OK
Practice address
308 N W 153Rd Street
Edmond, OK 73013
Phone
(405) 888-9949
Fax
(405) 272-7455
NPI assigned
Aug 26, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R98967 OK Primary

Addresses

Primary practice location

308 N W 153Rd Street
Edmond, OK 73013

Mailing address

308 N W 153Rd Street
Edmond, OK 73013
Phone (405) 888-9949

Other identifiers 1

IdentifierTypeStateIssuer
200557160AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141110001602 OK Practitioner - Nurse Practitioner 6800018730 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Optimum Primary Care PLLC CurrentSince Jul 1, 2020 Accepting new patients
Optimum Care Hospitalist Group PLLC CurrentSince Feb 1, 2018 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Peter Lafon, DO, PLLC PastSince Sep 4, 2014 Accepting new patients

Locations

1501 E 19th St
Edmond, OK 73013
Phone (405) 348-6611

105 S Bryant Ave
Ste 108
Edmond, OK 73034
Phone (405) 359-9669

1104 E State Highway 152
#1
Mustang, OK 73064
Phone (405) 376-9544

Organizations & group practices 4

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": "1409011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485475200000",
    "number": "1295135341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 N W 153RD STREET",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "73013",
            "telephone_number": "405-888-9949",
            "fax_number": "405-272-7455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 N W 153RD STREET",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "73013",
            "telephone_number": "405-888-9949",
            "fax_number": "405-272-7455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOEBER",
        "first_name": "MATTHEW",
        "middle_name": "K",
        "name_prefix": "Mr.",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-26",
        "last_updated": "2017-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "R98967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200557160A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

Verify at the official NPI Registry.