NPIMap

Individual provider Active NPI

Matthew Theodore Draelos, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Edmond, OK
National Provider Identifier
1437221694
Registry record updated Oct 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
15748 Issued in OK
Practice address
200 N Bryant Ave
Suite 100
Edmond, OK 73034-6273
Phone
(405) 330-2362
Fax
(405) 330-2363
NPI assigned
Nov 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 15748 OK Primary

Addresses

Primary practice location

200 N Bryant Ave
Suite 100
Edmond, OK 73034-6273

Mailing address

200 N Bryant Ave
Suite 100
Edmond, OK 73034-6273
Phone (405) 330-2362

Other identifiers 1

IdentifierTypeStateIssuer
OK401293OtherOKMEDICARE TPAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080701000286 OK Practitioner - EndocrinologyPractitioner - Internal Medicine 7315939022 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
University of New Mexico School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

15951 Little Axe Dr
Norman, OK 73026-9088
Phone (405) 447-0300

1600 Medical Ctr Dr
Edmond, OK 73034-6357
Phone (405) 330-2362

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Matthew T Draelos MD PC Endocrinology, Diabetes & Metabolism CurrentSince May 22, 2008 Accepting new patients
Absentee Shawnee Tribal Health Authority, Inc. Current Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

1600 Medical Center Dr
Edmond, OK 73034
Phone (405) 330-2362

200 N Bryant Ave
Ste 100
Edmond, OK 73034
Phone (405) 330-2362

15951 Little Axe Dr
Norman, OK 73026
Phone (405) 447-0300

2029 Gordon Cooper Dr
Shawnee, OK 74801
Phone (405) 878-4702

Interoperability endpoints

  • Direct secure messaging: mdraelos182553@direct.integrisok.com

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224633600000",
    "number": "1437221694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N BRYANT AVE",
            "address_2": "SUITE 100",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730346273",
            "telephone_number": "405-330-2362",
            "fax_number": "405-330-2363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N BRYANT AVE",
            "address_2": "SUITE 100",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730346273",
            "telephone_number": "405-330-2362",
            "fax_number": "405-330-2363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRAELOS",
        "first_name": "MATTHEW",
        "middle_name": "THEODORE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2008-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "OK",
            "license": "15748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE TPAN",
            "identifier": "OK401293",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

Verify at the official NPI Registry.