NPIMap

Individual provider Active NPI

Gary Wayne Gulickson, CRNA

  • Certified Registered Nurse Anesthetist
  • Oklahoma City, OK
National Provider Identifier
1316243850
Registry record updated Aug 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
75560 Issued in OK
Practice address
5501 N Portland Ave
Oklahoma City, OK 73112-2074
Phone
(405) 604-6000
NPI assigned
Feb 1, 2011
Last updated
Aug 13, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 75560 OK Primary
Certified Registered Nurse Anesthetist 367500000X 85310 TX

Addresses

Primary practice location

5501 N Portland Ave
Oklahoma City, OK 73112-2074

Mailing address

4500 S Garnett Rd
Suite 300
Tulsa, OK 74146-5229
Phone (844) 625-2312

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150707001725 OK Practitioner - Certified Registered Nurse Anesthetist (Crna) 6002128915 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Medical Professionals PLLCGroup PAC ID 5991970279, 103 clinicians
Deaconess Anesthesia Services, LLCGroup PAC ID 0042587842, 21 clinicians
Portland Anesthesia Services LLCGroup PAC ID 8224512512, 21 clinicians

Practice addresses (Care Compare)

4801 Integris Pkwy
Edmond, OK 73034-8864
Phone (405) 713-4565

5501 N Portland Ave
Oklahoma City, OK 73112-2074
Phone (405) 604-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
75560OKMDCertified Registered Nurse Anesthetist
85310TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Western Oklahoma Anesthesia Consultants PLLC CurrentSince Jul 1, 2022 Accepting new patients
Deaconess Anesthesia Services LLC Nurse Anesthetist, Certified Registered CurrentSince May 15, 2017 Accepting new patients
Anesthesia Medical Professionals, PLLC CurrentSince Jan 1, 2023 Accepting new patients

Locations

4801 Integris Pkwy
Edmond, OK 73034
Phone (405) 657-3000

2825 Parklawn Dr
Oklahoma City, OK 73110
Phone (405) 245-1453

3300 NW Expressway St
Fl 2
Oklahoma City, OK 73112
Phone (405) 251-2815

5501 N Portland Ave
Oklahoma City, OK 73112
Phone (405) 604-6000

3701 E Main St
Weatherford, OK 73096
Phone (580) 772-5551

900 17th St
Woodward, OK 73801
Phone (405) 610-4411

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1296518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439424000000",
    "number": "1316243850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 S GARNETT RD",
            "address_2": "SUITE 300",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741465229",
            "telephone_number": "844-625-2312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 N PORTLAND AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731122074",
            "telephone_number": "405-604-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULICKSON",
        "first_name": "GARY",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-01",
        "last_updated": "2015-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OK",
            "license": "75560",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "85310",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.