Individual provider Active NPI

Katharine Smith Raun, PA-C

  • Physician Assistant
  • Moore, OK
National Provider Identifier
1306497292
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3115 Issued in OK
Practice address
1105 SW 30TH CT
Moore, OK 73160-2887
Phone
(405) 676-5114
NPI assigned
Sep 23, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3115 OK Primary

Addresses

Primary practice location

1105 SW 30TH CT
Moore, OK 73160-2887

Mailing address

1105 SW 30TH CT
Moore, OK 73160-2887
Phone (405) 676-5114

Other practice location 1

4400 N Lincoln Blvd
Oklahoma City, OK 73105-5104
Phone (405) 424-7711

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200331003326 OK Practitioner - Physician Assistant 9032548714 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Balance Womens Health LLCGroup PAC ID 3476927740, 89 clinicians

Practice addresses (Care Compare)

1105 SW 30TH CT
Moore, OK 73160-2887
Phone (405) 378-2727

1113 SW 30TH CT
Moore, OK 73160-2887
Phone (405) 378-2727

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3115OKMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.katharineraun@148561.advancedmd-direct.com

Organizations & group practices 1

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": "1569196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1306497292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 SW 30TH CT",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731602887",
            "telephone_number": "405-676-5114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 SW 30TH CT",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731602887",
            "telephone_number": "405-676-5114"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4400 N Lincoln Blvd",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731055104",
            "country_code": "US",
            "telephone_number": "405-424-7711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAUN",
        "first_name": "KATHARINE",
        "middle_name": "SMITH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-23",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "3115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moore, OK

Sources for this page

Verify at the official NPI Registry.