Autum Michole Caldwell, P.A. - C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2114 Issued in OK

Practice address

6565 S Yale Ave
Suite 503
Tulsa, OK 74136-8327

Phone

(918) 494-8333

Fax

(918) 494-8334

NPI assigned

Aug 16, 2012

Last updated

Nov 12, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Autum Michole Lacey Former name

Medicare fee-for-service enrollment

Enrolled in OK

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 1

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southside Dermatology PLLCGroup PAC ID 9234487554, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00426

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.

• Southside Dermatology PLLC

  • Dermatology Physician
  • Tulsa, OK
  • NPI 1750877072
  Medicare reassignment Care Compare group
• Jeff Alexander, MD, PC

  • Specialist
  • Tulsa, OK
  • NPI 1104852557
  Medicare reassignment
• Southside Dermatology PLLC

  • Dermatology Physician
  • Broken Arrow, OK
  • NPI 1073263380
  NPD
• Southside Dermatology PLLC

  • Dermatology Physician
  • Muskogee, OK
  • NPI 1205586500
  NPD
• Sergio Marano O.D. Mark Grisar O.D. PC

  dba Yonkers Eye Exam

  • Optometrist
  • Yonkers, NY
  • NPI 1992783864
  NPD (past)

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

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352678400000",
    "number": "1396093647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6565 S YALE AVE",
            "address_2": "SUITE 503",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741368327",
            "telephone_number": "918-494-8333",
            "fax_number": "918-494-8334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6565 S YALE AVE",
            "address_2": "SUITE 503",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741368327",
            "telephone_number": "918-494-8333",
            "fax_number": "918-494-8334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALDWELL",
        "first_name": "AUTUM",
        "middle_name": "MICHOLE",
        "credential": "P.A. - C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-16",
        "last_updated": "2012-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUTUM",
            "last_name": "LACEY",
            "middle_name": "MICHOLE",
            "credential": "P.A. - C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emily Calder, ATC
• Mark M Calder, MD/MPH
• Emily Calderon
• Caldwell Medical Group of North Tulsa LLC
• Caldwell Toxicology Labs LLC (Cogent Medical Lab LLC)
• Elizabeth Caldwell
• Everette Brent Caldwell Jr.
• John Dennis Caldwell
• Kathie Ann Caldwell, LCSW
• Kristen Caldwell, LPC

• Physician Assistant in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.