NPIMap

Individual provider Active NPI

Audra Michelle McCall, PAC

  • Physician Assistant
  • Broken Arrow, OK
National Provider Identifier
1306845524
Registry record updated Aug 31, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1097 Issued in OK
Practice address
2950 S Elm PL
Ste 256
Broken Arrow, OK 74012-7877
Phone
(918) 449-3720
Fax
(918) 449-3725
NPI assigned
Jul 19, 2005
Last updated
Aug 31, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2010

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 PA1097 OK Primary

Addresses

Primary practice location

2950 S Elm PL
Ste 256
Broken Arrow, OK 74012-7877

Mailing address

6600 S Yale Ave
Ste 1400
Tulsa, OK 74136-3310
Phone (918) 488-6001

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
I20040916000528 OK Practitioner - Physician Assistant 1052388162 Reassigns benefits to 2 organizations

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
Telehealth
Offers telehealth services
Group practices
Green Country Behavioral Health Services, Inc.Group PAC ID 8022019017, 14 clinicians

Practice addresses (Care Compare)

619 N Main St
Muskogee, OK 74401-4431
Phone (918) 682-8407

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA1097OKMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Warren Clinic Inc CurrentSince Nov 21, 2010 Accepting new patients
Warren Clinic Inc Past Accepting new patients
Warren Clinic Vinita Soonercare Group Past Accepting new patients
Warren Clinic Medicaid Group 100739490B Past Accepting new patients
Warren Clinic Kelly Pediatrics Soonercare Group Past Accepting new patients
Warren Clinic Stillwater Soonercare Past Accepting new patients
Warren Clinic Vinita Fee for Service Group Past Accepting new patients
Warren Clinic Memorial South Pediatrics Soonercare Group Past Accepting new patients
Warren Clinic South Family Medicine Soonercare Group Past Accepting new patients
Warren Clinic Sand Springs Soonercare Group Past Accepting new patients
Warren Clinic Broken Arrow Pediatrics Soonercare Group Past Accepting new patients

Locations

6160 S Yale Ave
Tulsa, OK 74136
Phone (918) 492-7200

6600 S Yale Ave
Ste 1200
Tulsa, OK 74136
Phone (918) 488-6045

6600 S Yale Ave
Ste 1400
Tulsa, OK 74136
Phone (888) 247-0125

Organizations & group practices 12

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.

Hospital & facility affiliations 2

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": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283212800000",
    "number": "1306845524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 S YALE AVE",
            "address_2": "STE 1400",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363310",
            "telephone_number": "918-488-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 S ELM PL",
            "address_2": "STE 256",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740127877",
            "telephone_number": "918-449-3720",
            "fax_number": "918-449-3725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCALL",
        "first_name": "AUDRA",
        "middle_name": "MICHELLE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-19",
        "last_updated": "2010-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "PA1097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

Verify at the official NPI Registry.