Individual provider Active NPI

Anoushka Suzy Mullasseril

  • Internal Medicine Physician
  • Oklahoma City, OK
National Provider Identifier
1437751344
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
43409 Issued in OK
Practice address
800 Stanton L Young Blvd
Oklahoma City, OK 73104-5018
Phone
(405) 271-2316
NPI assigned
Nov 15, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 43409 OK Primary

Addresses

Primary practice location

800 Stanton L Young Blvd
Oklahoma City, OK 73104-5018

Mailing address

800 Stanton L Young Blvd # 6300
Oklahoma City, OK 73104-5018
Phone (405) 271-5963

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
I20240820004194 OK Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 1355889437

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
43409OKMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Oklahoma Internal Medicine CurrentSince Jun 9, 2024 Accepting new patients

Locations

800 Stanton L Young Blvd
#6300
Oklahoma City, OK 73104
Phone (405) 271-5963

Organizations & group practices 1

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": "1605398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1437751344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 STANTON L YOUNG BLVD # 6300",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045018",
            "telephone_number": "405-271-5963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 STANTON L YOUNG BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045018",
            "telephone_number": "405-271-2316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLASSERIL",
        "first_name": "ANOUSHKA",
        "middle_name": "SUZY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-15",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "43409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.