Individual provider Active NPI

Jay Robert Anderson, DO

  • Family Medicine Physician
  • Tulsa, OK
National Provider Identifier
1407218639
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
8830 Issued in OK
Practice address
591 E 36TH St N
Tulsa, OK 74106-1812
Phone
(918) 619-4400
Fax
(918) 634-7875
NPI assigned
Mar 26, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 8830 OK Primary

Addresses

Primary practice location

591 E 36TH St N
Tulsa, OK 74106-1812

Mailing address

PO Box 268838
Oklahoma City, OK 73126-8838
Phone (918) 660-3632

Other identifiers 1

IdentifierTypeStateIssuer
201325970AMedicaidOK

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address janderson201538@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241223003333 OK Practitioner - Family Practice 3779989686 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Col of Osteo Med of the Pacific at Lebanon, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

8005 E 106TH St
Ou Physicians Tulsa
Tulsa, OK 74133-6600
Phone (918) 634-7600

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Regents of the University of Oklahoma Ou Physicians Tulsa CurrentSince Jan 1, 2025 Accepting new patients

Locations

8005 E 106th St
Tulsa, OK 74133
Phone (918) 591-5711

591 E 36th St N
Tulsa, OK 74106
Phone (918) 619-8700

1111 S Saint Louis Ave
Tulsa, OK 74120
Phone (918) 619-4600

Interoperability endpoints

  • Direct secure messaging: janderson201538@samhealth.direct-ci.com

Organizations & group practices 1

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": "1458950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743638400000",
    "number": "1407218639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268838",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731268838",
            "telephone_number": "918-660-3632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 E 36TH ST N",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741061812",
            "telephone_number": "918-619-4400",
            "fax_number": "918-634-7875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JAY",
        "middle_name": "ROBERT",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-26",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "8830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201325970A",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "janderson201538@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "2870 NE West Devils Lake Rd",
            "city": "Lincoln City",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973675127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.