Individual provider Active NPI

Jordan Stauffer, DO

  • Internal Medicine Physician
  • Tulsa, OK
National Provider Identifier
1336766278
Registry record updated Jun 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2020017267 Issued in MO
Practice address
1923 S Utica Ave
Tulsa, OK 74104-6520
Phone
(417) 385-7976
NPI assigned
Jun 26, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2020017267 MO Primary

Addresses

Primary practice location

1923 S Utica Ave
Tulsa, OK 74104-6520

Mailing address

1923 S Utica Ave
Tulsa, OK 74104-6520
Phone (417) 385-7976

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231018004101 OK Practitioner - Internal Medicine 1254754922 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Usacs Observation Medicine Services of Oklahoma, LLCGroup PAC ID 9931562956, 203 clinicians

Practice addresses (Care Compare)

1923 S Utica Ave
Tulsa, OK 74104-6520
Phone (918) 744-3131

300 Rockefeller Dr
Muskogee, OK 74401-5075
Phone (918) 684-2101

Hospital & facility affiliations

  • Ascension St John Medical Center Hospital, Tulsa, OK, CCN 370114
  • Ascension St John Jane Phillips Hospital, Bartlesville, OK, CCN 370018

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Medicine Physicians of Texas, PLLC Internal Medicine CurrentSince Sep 2, 2023 Accepting new patients
Usacs Observation Medicine Services of Oklahoma, LLC CurrentSince Oct 16, 2024 Accepting new patients
St John Medical Center Inc Past Accepting new patients

Locations

300 Rockefeller Dr
Muskogee, OK 74401
Phone (918) 682-5501

1000 N Lee Ave
Oklahoma City, OK 73102
Phone (405) 272-6152

6161 S Yale Ave
Tulsa, OK 74136
Phone (918) 494-2200

1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345

Organizations & group practices 3

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 4

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": "1593129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1336766278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1923 S UTICA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741046520",
            "telephone_number": "417-385-7976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1923 S UTICA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741046520",
            "telephone_number": "417-385-7976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAUFFER",
        "first_name": "JORDAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-26",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2020017267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.