Individual provider Active NPI

Rachel Mathew, APRN-CNP

  • Nurse Practitioner
  • Tulsa, OK
National Provider Identifier
1447530811
Registry record updated Mar 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
78436 Issued in OK
Practice address
1923 S Utica Ave
Tulsa, OK 74104-6520
Phone
(918) 748-7650
Fax
(918) 403-6341
NPI assigned
Aug 17, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 78436 OK Primary

Addresses

Primary practice location

1923 S Utica Ave
Tulsa, OK 74104-6520

Mailing address

1923 S Utica Ave
Tulsa, OK 74104-6520
Phone (918) 748-7650

Other identifiers 1

IdentifierTypeStateIssuer
200399480AMedicaidOK

Other names 1

  • Rachalamma Jacob Former name

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120424000172 OK Practitioner - Nurse Practitioner 0143482950 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. John Physicians, Inc.Group PAC ID 2567366495, 262 clinicians

Practice addresses (Care Compare)

1705 E 19TH St
Tulsa, OK 74104-5410

1923 S Utica Ave
Tulsa, OK 74104-6520
Phone (918) 744-2071

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc CurrentSince Jan 19, 2012 Accepting new patients
St. John Physicians, Inc. CurrentSince Jan 19, 2012 Accepting new patients

Locations

1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345

1705 E 19th St
Ste 304
Tulsa, OK 74104
Phone (918) 748-7660

1919 S Wheeling Ave
Ste 500
Tulsa, OK 74104
Phone (918) 293-6200

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

Interoperability endpoints

  • Direct secure messaging: rachel.mathew@direct.stjohnhealthsystem.com

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.

Hospital & facility affiliations 2

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": "1313539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520467200000",
    "number": "1447530811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1923 S UTICA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741046520",
            "telephone_number": "918-748-7650",
            "fax_number": "918-403-6341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1923 S UTICA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741046520",
            "telephone_number": "918-748-7650",
            "fax_number": "918-403-6341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "RACHEL",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-17",
        "last_updated": "2018-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OK",
            "license": "78436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200399480A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RACHALAMMA",
            "last_name": "JACOB",
            "credential": "APRN-CNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.