Individual provider Active NPI

Jeffrey Ariel Porras, M.D.

  • Specialist
  • Oklahoma City, OK
National Provider Identifier
1417987249
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
23554 Issued in OK
Practice address
1025 Straka Ter
Oklahoma City, OK 73139-2544
Phone
(405) 632-6688
Fax
(405) 604-0708
NPI assigned
Jul 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 23554 OK Primary

Addresses

Primary practice location

1025 Straka Ter
Oklahoma City, OK 73139-2544

Mailing address

1025 Straka Ter
Oklahoma City, OK 73139-2544
Phone (405) 632-6688

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
I20050517001013 OK Practitioner - Family Practice 4183661549 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1987
Medicare assignment
May accept Medicare assignment
Group practices
Total Primary Care PCGroup PAC ID 7618238924, 2 clinicians

Practice addresses (Care Compare)

5850 NW 72 ND PL
Warr Acres, OK 73132
Phone (405) 470-7947

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Total Primary Care PC CurrentSince Jan 18, 2018 Accepting new patients
Deaconess Physician Services LLC Past Accepting new patients

Locations

6301 N Meridian Ave
Ste 103
Oklahoma City, OK 73112
Phone (405) 470-7947

5850 NW 72nd Pl
Warr Acres, OK 73132
Phone (405) 470-7947

Organizations & group practices 2

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": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417987249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 STRAKA TER",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731392544",
            "telephone_number": "405-632-6688",
            "fax_number": "405-604-0708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 STRAKA TER",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731392544",
            "telephone_number": "405-632-6688",
            "fax_number": "405-604-0708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORRAS",
        "first_name": "JEFFREY",
        "middle_name": "ARIEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OK",
            "license": "23554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.