Individual provider Active NPI

Stefanie Nanette Forrester, PAC

  • Medical Physician Assistant
  • Oklahoma City, OK
National Provider Identifier
1366719080
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA5503 Issued in OK
Practice address
309 S Ann Arbor Ave
Oklahoma City, OK 73128-1112
Phone
(405) 948-4900
Fax
(405) 948-4933
NPI assigned
Nov 23, 2011
Last updated
Dec 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA22003 CA
Medical Physician Assistant 363AM0700X PA5503 OK Primary

Addresses

Primary practice location

309 S Ann Arbor Ave
Oklahoma City, OK 73128-1112

Mailing address

4913 W Reno Ave
Oklahoma City, OK 73127-6339
Phone (405) 948-4900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120104000761 CA Practitioner - Physician Assistant 9234305707 Reassigns benefits to 2 organizations
I20190819003381 TX Practitioner - Physician Assistant 9234305707 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Oklahoma American Indian Health Council, Inc.Group PAC ID 3476617374, 60 clinicians

Practice addresses (Care Compare)

309 S Ann Arbor
Oklahoma City Indian Clinic
Oklahoma City, OK 73128-1112
Phone (405) 948-4900

Merit-based Incentive Payment System (MIPS)

Final score
47.39 of 100Reported as group
Quality
13.78
Promoting interoperability
0
Improvement activities
40
Cost
81.09

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5503OKMDGeneral Practice Dentistry
PA22003CAMDMedical Physician Assistant
PA5503OKMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mendocino Coast Clinics Inc Current Accepting new patients
Mendocino Coast Clinics, Inc. CurrentSince Nov 2, 2020 Accepting new patients
Mendocino Coast Clinics Inc CurrentSince Nov 2, 2020 Accepting new patients
Southwest Oklahoma Two Medical Group, PLLC Past Accepting new patients
UCSF Health Community Hospitals Past Accepting new patients

Locations

205 South St
Fort Bragg, CA 95437
Phone (707) 961-4088

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

NPI Registry JSON

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

{
    "created_epoch": "1322006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735171200000",
    "number": "1366719080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4913 W RENO AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731276339",
            "telephone_number": "405-948-4900",
            "fax_number": "405-948-4933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 S ANN ARBOR AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731281112",
            "telephone_number": "405-948-4900",
            "fax_number": "405-948-4933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORRESTER",
        "first_name": "STEFANIE",
        "middle_name": "NANETTE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-23",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA22003",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "PA5503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.