Individual provider Active NPI

Jin Kong, M.D.

  • Internal Medicine Physician
  • Ada, OK
National Provider Identifier
1376793208
Registry record updated Mar 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
T-02232 Issued in KS
Practice address
1921 Stonecipher Dr
Ada, OK 74820-3439
Phone
(580) 436-3980
NPI assigned
Sep 29, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2013

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 T-02232 KS Primary

Addresses

Primary practice location

1921 Stonecipher Dr
Ada, OK 74820-3439

Mailing address

1921 Stonecipher Dr
Ada, OK 74820-3439
Phone (580) 421-4570

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20090623000149 TX Practitioner - Internal Medicine 9537210190 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1982
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)

5208 W Reno Ave
Oklahoma City Indian Clinic
Oklahoma City, OK 73128-1112
Phone (405) 948-4900

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
T-02232KSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Oklahoma American Indian Health Council, Inc. CurrentSince Jun 1, 2013 Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

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

5208 W Reno Ave
Oklahoma City, OK 73127
Phone (405) 948-4900

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

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363737600000",
    "number": "1376793208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 STONECIPHER DR",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748203439",
            "telephone_number": "580-421-4570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 STONECIPHER DR",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748203439",
            "telephone_number": "580-436-3980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONG",
        "first_name": "JIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-29",
        "last_updated": "2013-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "T-02232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ada, OK

Sources for this page

Verify at the official NPI Registry.