Individual provider Active NPI

Austin Kurt Ederer

  • Physician Assistant
  • Norman, OK
National Provider Identifier
1417467762
Registry record updated May 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3400 W Tecumseh Rd Ste 101
Norman, OK 73072-1810
Phone
(405) 360-6764
Fax
(405) 360-6769
NPI assigned
Oct 1, 2017
Last updated
May 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

3400 W Tecumseh Rd Ste 101
Norman, OK 73072-1810

Mailing address

3400 W Tecumseh Rd Ste 101
Norman, OK 73072-1810
Phone (405) 360-6764

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180110001086 OK Practitioner - Physician Assistant 3375802770 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ortho CentralGroup PAC ID 9830526615, 33 clinicians

Practice addresses (Care Compare)

1624 Midtown PL
Suite a
Midwest City, OK 73130-6347
Phone (405) 360-6764

2201 Trae Young Dr
Norman, OK 73069-5091

3300 Healthplex Pkwy
Norman, OK 73072-9749
Phone (405) 515-1000

3400 E Tecumseh Rd
Norman, OK 73072-1810

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ortho Central CurrentSince May 28, 2024 Accepting new patients
Ortho Central CurrentSince May 28, 2024 Accepting new patients
Mercy Hospital Logan County, Inc CurrentSince Jan 29, 2018 Accepting new patients
Mercy Hospital Logan County, Inc CurrentSince Jan 29, 2018 Accepting new patients
Summit Medical Center Past Accepting new patients
Ortho Central Past Accepting new patients
Ortho Plus Holdings LLC Past Accepting new patients

Locations

200 S Academy Rd
Guthrie, OK 73044
Phone (405) 260-4165

3300 Healthplex Pkwy
Norman, OK 73072
Phone (405) 329-4102

3400 W Tecumseh Rd
Ste 101
Norman, OK 73072
Phone (405) 515-0649

Organizations & group practices 10

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1506816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715558400000",
    "number": "1417467762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 W TECUMSEH RD STE 101",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730721810",
            "telephone_number": "405-360-6764",
            "fax_number": "405-360-6769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 W TECUMSEH RD STE 101",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730721810",
            "telephone_number": "405-360-6764",
            "fax_number": "405-360-6769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDERER",
        "first_name": "AUSTIN",
        "middle_name": "KURT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-01",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norman, OK

Sources for this page

Verify at the official NPI Registry.