NPIMap

Organization Active NPI

Medwise LLC

  • Durable Medical Equipment & Medical Supplies
  • Tulsa, OK
National Provider Identifier
1407656572
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
MEDWISE LLC
Practice address
8105 E 68TH St
Tulsa, OK 74133-2236
Phone
(918) 727-2811
NPI assigned
Mar 17, 2025
Last updated
Mar 17, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDWISE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

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

Authorized official

Name
Dennis Sidney Blackstad, MDNPI 1710040894
Title
President
Phone
(918) 605-6582

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

8105 E 68TH St
Tulsa, OK 74133-2236

Mailing address

12902 E 51St St
Tulsa, OK 74134-6712
Phone (918) 994-3476

Other names 1

  • MedWise Urgent Care - Woodland Hills Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250513000322 OK DME Supplier - Other 8820410970 Practice locations: Tulsa, OK

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D2222055Medwise, LLC8105 E 68TH St, Tulsa, OK 74133Certificate of waiverApr 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Medwise LLC5 organizations share this tax ID, including this one
Part of
Medwise LLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

14801 S Memorial Dr
Bixby, OK 74008
Phone (918) 727-2820

5795 S Elm Pl
Broken Arrow, OK 74011
Phone (918) 716-5437

1400 S Wood Dr
Okmulgee, OK 74447
Phone (918) 994-3476

6336 E Admiral Pl
Tulsa, OK 74115
Phone (918) 727-2830

1520 SW 1st St
Wagoner, OK 74467
Phone (918) 727-2790

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 42

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1742169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742169600000",
    "number": "1407656572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12902 E 51ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741346712",
            "telephone_number": "918-994-3476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8105 E 68TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741332236",
            "telephone_number": "918-727-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDWISE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDWISE LLC",
        "enumeration_date": "2025-03-17",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A",
        "authorized_official_last_name": "BLACKSTAD",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "SIDNEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-605-6582",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedWise Urgent Care - Woodland Hills",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.