Active NPI
Edison Dale Jeffus Jr., PHD
- Clinical Neuropsychologist
- Tulsa, OK
National Provider Identifier
1407905284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 636
- Practice address
- 3220 S Peoria Ave
Suite 2
Tulsa, OK 74105-2003 - Phone
- (918) 749-5506
- Fax
- (918) 749-5506
- NPI assigned
- Jan 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 636 | OK | Primary |
| Clinical Psychologist | 103TC0700X | 636 | OK |
Addresses
Primary practice location
3220 S Peoria Ave
Suite 2
Tulsa, OK 74105-2003
Mailing address
509 W 33Rd St
Sand Springs, OK 74063-2934
Phone (918) 241-1149
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120224000333 | OK | Practitioner - Clinical Psychologist | 4385802156 | Practice locations: Tulsa, OK |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3220 S Peoria Ave
Tulsa, OK 74105-2003
Phone (918) 749-5506
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 636 | OK | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325030400000",
"number": "1407905284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "509 W 33RD ST",
"city": "SAND SPRINGS",
"state": "OK",
"postal_code": "740632934",
"telephone_number": "918-241-1149",
"fax_number": "918-749-5506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3220 S PEORIA AVE",
"address_2": "SUITE 2",
"city": "TULSA",
"state": "OK",
"postal_code": "741052003",
"telephone_number": "918-749-5506",
"fax_number": "918-749-5506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEFFUS",
"first_name": "EDISON",
"middle_name": "DALE",
"name_suffix": "Jr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2011-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "OK",
"license": "636",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OK",
"license": "636",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Dec 28, 2011; 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.