Premier Pediatric and Adolescent Care of Bixby

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

PREMIER PEDIATRIC AND ADOLESCENT CARE OF BIXBY

Practice address

7814 E 121St St
Bixby, OK 74008

Phone

(918) 943-5777

NPI assigned

Mar 12, 2020

Last updated

Mar 13, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ryan Mundy, MDNPI 1447488762

Title

Owner

Phone

(918) 943-5777

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ryan T Mundy, M.D.

  • Pediatrics Physician
  • Muskogee, OK
  • NPI 1447488762
  NPD (past) Authorized official
• Danielle M Morgan, M.D.

  • Pediatrics Physician
  • Tulsa, OK
  • NPI 1780974691
  NPD
• Clay Thomas Smith, DO

  • Pediatrics Physician
  • Bixby, OK
  • NPI 1790361327
  NPD
• Aishia Gladney, APRN

  • Family Nurse Practitioner
  • Tulsa, OK
  • NPI 1427630102
  NPD (past)

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

{
    "created_epoch": "1583971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584057600000",
    "number": "1326674177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5913 E 108TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741377057",
            "telephone_number": "918-853-2710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7814 E 121ST ST",
            "city": "BIXBY",
            "state": "OK",
            "postal_code": "74008",
            "telephone_number": "918-943-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PEDIATRIC AND ADOLESCENT CARE OF BIXBY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-12",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A",
        "authorized_official_last_name": "MUNDY",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-943-5777",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Ann Pettit, PMHNP
• Willis Franklin Phelps, M.D.
• Glenna G Pierce-Thorstenberg, LCSW
• Bruna Barros Popp, RD
• Elijah O Powis, DPT
• Sean Michael Price, PHARM.D
• Prophylaxis Healthcare LLC (Axis Behavioral Health)
• Prophylaxis Healthcare LLC (Axis HealthCare)
• Prophylaxis Primary Care and Behavioral Healthcare Services Inc
• Eliana Provenzano-Lewis

• Pediatrics Physician in Bixby, OK
• Providers in Bixby, OK by specialty
• Pediatrics Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.