Active NPI
Bennett Graham Oden, MD
- Family Medicine Physician
- Des Moines, IA
National Provider Identifier
1427665157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R-12268
- Practice address
- 1111 6TH Ave
Des Moines, IA 50314-2613 - Phone
- (515) 643-2682
- Fax
- (515) 643-5802
- NPI assigned
- Sep 27, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | R-12268 | IA | Primary |
Addresses
Primary practice location
1111 6TH Ave
Des Moines, IA 50314-2613
Mailing address
PO Box 1475
Des Moines, IA 50305-1475
Phone (515) 643-2682
Other practice location 1
2912 Cummings Dr
Oklahoma City, OK 73107-2117
Phone (405) 227-1917
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Oklahoma College of Medicine, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1921 Stonecipher Dr
Ada, OK 74820-3439
Phone (580) 436-3980
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chickasaw Nation Division of Health | Current | Accepting new patients | |
| Chickasaw Nation Division of Health | Current | Accepting new patients | |
| Chickasaw Nation Division of Health | Current | Accepting new patients |
Locations
1921 Stonecipher Dr
Ada, OK 74820
Phone (580) 421-4570
2510 Chickasaw Blvd
Ardmore, OK 73401
Phone (580) 226-8181
1438 Hardcastle Blvd
Purcell, OK 73080
Phone (405) 527-4700
817 E 6th St
Tishomingo, OK 73460
Phone (580) 371-2392
Interoperability endpoints
- boden22305@direct.chickasawnationhealth.net
Organizations & group practices 3
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.
-
- Primary Care Clinic/Center
- Tishomingo, OK
- NPI 1649330242
-
- Home Health Agency
- Ada, OK
- NPI 1811739071
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Ada, OK
- NPI 1255364923
-
- Primary Care Clinic/Center
- Tishomingo, OK
- NPI 1649330242
Hospital
-
- Primary Care Clinic/Center
- Ada, OK
- NPI 1962563148
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624233600000",
"number": "1427665157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1475",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503051475",
"telephone_number": "515-643-2682",
"fax_number": "515-643-5802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 6TH AVE",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503142613",
"telephone_number": "515-643-2682",
"fax_number": "515-643-5802"
}
],
"practiceLocations": [
{
"address_1": "2912 Cummings Dr",
"address_purpose": "LOCATION",
"city": "Oklahoma City",
"state": "OK",
"postal_code": "731072117",
"country_code": "US",
"telephone_number": "405-227-1917",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ODEN",
"first_name": "BENNETT",
"middle_name": "GRAHAM",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-27",
"last_updated": "2021-06-21",
"certification_date": "2021-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "R-12268",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Des Moines, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; 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.