Organization Active NPI

My Doctor Family Care, LLC

  • Family Medicine Physician
  • Tulsa, OK
National Provider Identifier
1316629868
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MY DOCTOR FAMILY CARE, LLC
Practice address
10106 S Sheridan Rd Ste B
Tulsa, OK 74133-6776
Phone
(918) 619-9400
Fax
(918) 600-2980
NPI assigned
Aug 3, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

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

Authorized official

Name
Stanley R Stacy, DONPI 1225018757
Title
Physician/Member
Phone
(918) 619-9400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

10106 S Sheridan Rd Ste B
Tulsa, OK 74133-6776

Mailing address

10106 S Sheridan Rd Ste B
Tulsa, OK 74133-6776
Phone (918) 619-9400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231004003723 OK Part B Supplier - Clinic/Group Practice 6800241233 Receives reassigned benefits from 2 practitioners
Practice locations: Tulsa, OK

National Provider Directory

National Provider Directory

Locations

10106 S Sheridan Rd
Ste B
Tulsa, OK 74133
Phone (918) 619-9400

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1691020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1316629868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10106 S SHERIDAN RD STE B",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741336776",
            "telephone_number": "918-619-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10106 S SHERIDAN RD STE B",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741336776",
            "telephone_number": "918-619-9400",
            "fax_number": "918-600-2980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY DOCTOR FAMILY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-03",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "STACY",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHYSICIAN/MEMBER",
        "authorized_official_telephone_number": "918-619-9400",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.