Active NPI
Ryan T Mundy, M.D.
- Pediatrics Physician
- Muskogee, OK
National Provider Identifier
1447488762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 27222
- Practice address
- 2009 N Main St
Premier Pediatrics
Muskogee, OK 74401-4131 - Phone
- (918) 816-4024
- Fax
- (918) 816-4025
- NPI assigned
- Jun 25, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 27222 | OK | Primary |
Addresses
Primary practice location
2009 N Main St
Premier Pediatrics
Muskogee, OK 74401-4131
Mailing address
2009 N Main St
Premier Pediatrics
Muskogee, OK 74401-4131
Phone (918) 816-4024
Other practice location 1
7814 E 121st St S
Bixby, OK 74008-2304
Phone (918) 943-5777
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27222 | OK | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Francis Hospital Muskogee Inc | Past | Accepting new patients | |
| Summit Medical Center | Past | Accepting new patients | |
| Premier Pediatric and Adolescent Care of Bixby | Pediatrics | Past | Accepting new patients |
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.
-
- Pediatrics Physician
- Bixby, OK
- NPI 1326674177
-
- General Acute Care Hospital
- Muskogee, OK
- NPI 1386188837
-
- General Acute Care Hospital
- Edmond, OK
- NPI 1356574560
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596412800000",
"number": "1447488762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2009 N MAIN ST",
"address_2": "PREMIER PEDIATRICS",
"city": "MUSKOGEE",
"state": "OK",
"postal_code": "744014131",
"telephone_number": "918-816-4024",
"fax_number": "918-816-4025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2009 N MAIN ST",
"address_2": "PREMIER PEDIATRICS",
"city": "MUSKOGEE",
"state": "OK",
"postal_code": "744014131",
"telephone_number": "918-816-4024",
"fax_number": "918-816-4025"
}
],
"practiceLocations": [
{
"address_1": "7814 E 121st St S",
"address_purpose": "LOCATION",
"city": "Bixby",
"state": "OK",
"postal_code": "740082304",
"country_code": "US",
"telephone_number": "918-943-5777",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MUNDY",
"first_name": "RYAN",
"middle_name": "T",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-25",
"last_updated": "2020-08-03",
"certification_date": "2020-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OK",
"license": "27222",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Muskogee, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.