Specialty Clinics of St Anne PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

19756 Issued in OK

Legal business name

SPECIALTY CLINICS OF ST ANNE PLLC

Practice address

350 NE 12TH St
Guymon, OK 73942-3624

Phone

(580) 338-8700

Fax

(580) 338-8600

NPI assigned

Jul 19, 2006

Last updated

Feb 3, 2015By 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

Martin Bautista, M.D.NPI 1144249327

Title

MD

Phone

(580) 338-8700

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

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

CLIA laboratory certificates

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Panhandle Radiology PLLC

  • Diagnostic Radiology Physician
  • Guymon, OK
  • NPI 1104018571

  Member Of

  NPD member

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FDFFAA

Practitioners 3

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.

• Martin Bautista, M.D.

  • Internal Medicine Physician
  • Guymon, OK
  • NPI 1144249327
  Medicare reassignment Care Compare group NPD Authorized official
• Sylvia Tan, M.D.

  • Internal Medicine Physician
  • Guymon, OK
  • NPI 1700809720
  Medicare reassignment Care Compare group NPD
• Emmanuel Barias, MD

  • Family Medicine Physician
  • Oakhurst, NJ
  • NPI 1316998024

  OK

  Medicare reassignment NPD

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422921600000",
    "number": "1356360473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 NE 12TH ST",
            "city": "GUYMON",
            "state": "OK",
            "postal_code": "739423624",
            "telephone_number": "580-338-8700",
            "fax_number": "580-338-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 NE 12TH ST",
            "city": "GUYMON",
            "state": "OK",
            "postal_code": "739423624",
            "telephone_number": "580-338-8700",
            "fax_number": "580-338-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY CLINICS OF ST ANNE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2015-02-03",
        "status": "A",
        "authorized_official_last_name": "BAUTISTA",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "580-338-8700",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "26523",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "19772",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "19756",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100748490A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Britney Laine Scott, PTA
• L. Loyet Shafer, PH.D.
• Alisa R Sheldon
• Slater Medical Arts Clinic Inc
• Solutions on Staff, LLC
• Nicole L Spry
• SRP Guymon, LLC (Memorial Hospital of Texas County)
• Carmin Angel Stark, BS
• State of Oklahoma (Northwest Center For Behavioral Health)
• Jessica Brianne Stedje

• Internal Medicine Physician in Guymon, OK
• Providers in Guymon, OK by specialty
• Internal Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 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.