Lifestyle Medicine, Inc.

Primary specialty

Hematology (Internal Medicine) PhysicianTaxonomy code 207RH0000X

License

22105 Issued in OK

Legal business name

LIFESTYLE MEDICINE, INC.

Practice address

2405 E Skelly Dr
Tulsa, OK 74105-6006

Phone

(918) 488-9874

Fax

(918) 587-3437

NPI assigned

Jun 9, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Renae Mayer, MDNPI 1093752503

Title

Owner

Phone

(918) 488-9874

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Renae Lyne Mayer, M.D.

  • Internal Medicine Physician
  • Tulsa, OK
  • NPI 1093752503
  Medicare reassignment Authorized official
• Susan Chaiser Willard, DO

  • Family Medicine Physician
  • Tulsa, OK
  • NPI 1033179916
  NPD (past)

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

{
    "created_epoch": "1433808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433808000000",
    "number": "1366823932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2405 E SKELLY DR",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741056006",
            "telephone_number": "918-488-9874",
            "fax_number": "918-587-3437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2405 E SKELLY DR",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741056006",
            "telephone_number": "918-488-9874",
            "fax_number": "918-587-3437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTYLE MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-09",
        "last_updated": "2015-06-09",
        "status": "A",
        "authorized_official_last_name": "MAYER",
        "authorized_official_first_name": "RENAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-488-9874",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RH0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Hematology",
            "state": "OK",
            "license": "22105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Life Strategies International, Inc.
• Life'S Seasoning Counseling Service, LLC
• Lifeguard Anesthesia Services LLC
• Lifespan Speech and Language Services, LLC
• Lifestyle Medical Center, PLLC
• Lifting Spirits
• Tamica Liggins
• Lighthouse Psychiatry PLLC
• Sheila Ann Ligon, APRN-CNP
• Katrina Clovice Ligons, APRN

• Hematology (Internal Medicine) Physician in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Hematology (Internal Medicine) Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.