NPIMap

Individual provider Active NPI

Kelly Marak, D.O., M.S.

  • Internal Medicine Physician
  • Tahlequah, OK
National Provider Identifier
1316174675
Registry record updated Apr 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5679 Issued in OK
Practice address
1400 E Downing St
Tahlequah, OK 74464-3324
Phone
(918) 456-0641
NPI assigned
Jun 14, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 240394 MA
Internal Medicine Physician 207R00000X 5679 OK Primary

Addresses

Primary practice location

1400 E Downing St
Tahlequah, OK 74464-3324

Mailing address

1400 E Downing St
Tahlequah, OK 74464-3324

Other practice location 1

1705 E 19TH St
Ste 302
Tulsa, OK 74104-5410
Phone (432) 230-2622

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
I20160819001425 OK Practitioner - HospitalistPractitioner - Internal Medicine 3072808799 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
University of North Texas HSC, College of Osteopathic Med, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tahlequah Medical Group LLCGroup PAC ID 4082861349, 16 clinicians
Northeastern Health SystemGroup PAC ID 1456255025, 105 clinicians

Practice addresses (Care Compare)

1373 E Boone Street
Suite 2300
Tahlequah, OK 74464-3330
Phone (918) 456-0655

1400 E Downing St
Tahlequah, OK 74464-3324
Phone (918) 456-0641

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.91 of 100Reported as apm
Quality
76.55
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
90.91 of 100Reported as apm
Quality
76.55
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Master of Science

State licenses

LicenseStateTypeSpecialty
5679OKMDPhysical Therapist
240394MAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Health System Current Accepting new patients
St. John Physicians, Inc. Internal Medicine CurrentSince Jul 11, 2016 Accepting new patients
Northeastern Health System CurrentSince Jul 11, 2016 Accepting new patients
Tahlequah Medical Group LLC Internal Medicine CurrentSince Jul 1, 2021 Accepting new patients
St. John Physicians, Inc CurrentSince Jul 11, 2016 Accepting new patients
Northeastern Health System CurrentSince Jul 11, 2016 Accepting new patients
Northeastern Health System Past Accepting new patients
Northeastern Health System Past Accepting new patients

Locations

1400 E Downing St
Tahlequah, OK 74464
Phone (918) 456-0641

1373 E Boone St
Ste 2300
Tahlequah, OK 74464
Phone (918) 207-0025

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/932b43fb-c766-413c-a343-640549d20cb3/

Organizations & group practices 8

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 9

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": "1244937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587686400000",
    "number": "1316174675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E DOWNING ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E DOWNING ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643324",
            "telephone_number": "918-456-0641"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1705 E 19TH ST",
            "address_2": "STE 302",
            "address_purpose": "LOCATION",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045410",
            "country_code": "US",
            "telephone_number": "432-230-2622",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARAK",
        "first_name": "KELLY",
        "credential": "D.O., M.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-14",
        "last_updated": "2020-04-24",
        "certification_date": "2020-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MA",
            "license": "240394",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "5679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tahlequah, OK

Sources for this page

Verify at the official NPI Registry.