NPIMap

Individual provider Active NPI

Mikaela Rose Koivisto

  • Emergency Medicine Physician
  • Oklahoma City, OK
National Provider Identifier
1336991538
Registry record updated Mar 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
9185 Issued in OK
Practice address
4401 S Western Ave
Oklahoma City, OK 73109-3413
Phone
(405) 834-4573
NPI assigned
Apr 2, 2024
Last updated
Mar 29, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 29, 2026

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
Emergency Medicine Physician 207P00000X 9185 OK Primary

Addresses

Primary practice location

4401 S Western Ave
Oklahoma City, OK 73109-3413

Mailing address

4401 S Western Ave
Oklahoma City, OK 73109-3413
Phone (855) 696-2666

Other practice location 1

2401 W Wrangler Blvd
Seminole, OK 74868-1917
Phone (432) 758-5811

Other practice location 2

1500 N Green Ave
Purcell, OK 73080-1642
Phone (405) 527-6524

Other practice location 3

3701 E Main St
Weatherford, OK 73096-3309
Phone (580) 772-5551

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
I20250725003932 OK Practitioner - Emergency Medicine 5698282507 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Arkansas College of Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Physician Staffing 2 PLLCGroup PAC ID 3375886476, 13 clinicians
Emergency Physicians of Mid-America PCGroup PAC ID 2062638661, 86 clinicians
Grady Memorial HospitalGroup PAC ID 0648175778, 47 clinicians

Practice addresses (Care Compare)

1 E Clark Bass Blvd
McAlester, OK 74501-4209
Phone (405) 843-5855

1500 N Green Ave
Purcell, OK 73080-1642
Phone (405) 527-6524

2220 W Iowa Ave
Professional Medical Services
Chickasha, OK 73018-2738
Phone (405) 224-2300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9185OKMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians of Mid-America, P.C. Emergency Medicine CurrentSince Aug 1, 2025 Accepting new patients
Farmers Union Hospital Association CurrentSince Oct 30, 2025 Accepting new patients
Farmers Union Hospital Association CurrentSince Oct 30, 2025 Accepting new patients
South Central Emergency Services PC Emergency Medicine CurrentSince Jan 1, 2026 Accepting new patients
Grady Memorial Hospital Current Accepting new patients
Grady Memorial Hospital CurrentSince Dec 1, 2025 Accepting new patients

Locations

2100 W Iowa Ave
Chickasha, OK 73018
Phone (405) 224-2100

2220 W Iowa Ave
Chickasha, OK 73018
Phone (405) 224-2100

1800 W 1st St
Ste 3
Elk City, OK 73644
Phone (580) 225-4699

1 E Clark Bass Blvd
McAlester, OK 74501
Phone (918) 421-6941

200 2nd Ave SW
Miami, OK 74354
Phone (918) 540-7113

4401 S Western Ave
Oklahoma City, OK 73109
Phone (405) 636-7000

1500 N Green Ave
Purcell, OK 73080
Phone (405) 527-2250

2401 W Wrangler Blvd
Seminole, OK 74868
Phone (405) 303-4000

1102 W MacArthur St
Shawnee, OK 74804
Phone (405) 273-2270

1323 W 6th Ave
Stillwater, OK 74074
Phone (405) 372-1480

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

Interoperability endpoints

  • Direct secure messaging: mkoivisto365822@direct.integrisok.com
  • Direct secure messaging: mkoivisto556351@direct-ehr-ssmhc.com

Organizations & group practices 7

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 10

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": "1712016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774742400000",
    "number": "1336991538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 S WESTERN AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731093413",
            "telephone_number": "855-696-2666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 S WESTERN AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731093413",
            "telephone_number": "405-834-4573"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2401 W Wrangler Blvd",
            "address_purpose": "LOCATION",
            "city": "Seminole",
            "state": "OK",
            "postal_code": "748681917",
            "country_code": "US",
            "telephone_number": "432-758-5811",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 N Green Ave",
            "address_purpose": "LOCATION",
            "city": "Purcell",
            "state": "OK",
            "postal_code": "730801642",
            "country_code": "US",
            "telephone_number": "405-527-6524",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3701 E Main St",
            "address_purpose": "LOCATION",
            "city": "Weatherford",
            "state": "OK",
            "postal_code": "730963309",
            "country_code": "US",
            "telephone_number": "580-772-5551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOIVISTO",
        "first_name": "MIKAELA",
        "middle_name": "ROSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-02",
        "last_updated": "2026-03-29",
        "certification_date": "2026-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "9185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.