Nolen Dale Anderson, DO
Individual provider Active NPI Emergency Medicine Physician · Ardmore, OK
NPI 1477515484 · NPPES record last updated Mar 23, 2016
Key facts
- NPI
- 1477515484
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 4172 (OK)
- Practice address
- 1011 14TH Ave NW
Ardmore, OK 73401-1828 - Phone
- (580) 220-6658
- Fax
- (580) 220-6673
- NPI assigned
- Apr 5, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 2
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Clinic Oklahoma Communities
Practice addresses (Care Compare)
430 N Monte Vista St
Ada, OK 74820-4610
Phone (580) 332-2323
Hospital & facility affiliations
- Cross Timbers Hospice, Inc
- Mercy Hospital Ardmore, Inc
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of nail tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Cross Timbers Hospice |
Hospice | W-2 Managing Employee Operational/Managerial Control |
Jan 10, 2024 Jan 10, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050921000282 | OK | Practitioner - Emergency Medicine | 8426085812 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Clinic Oklahoma Communities | Current |
Accepting new patients | |
| Lightstar Emergency Physicians, PLLC | Emergency Medicine | Past | Accepting new patients |
| Mercy Hospital Ardmore, Inc. | Past | Accepting new patients |
Locations
430 N Monte Vista St
Ada, OK 74820
Phone (580) 226-1251
1011 14th Ave NW
Ardmore, OK 73401
Phone (580) 220-6658
4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962
4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 4172 | OK | Yes |
Addresses
Primary practice location
1011 14TH Ave NW
Ardmore, OK 73401-1828
Mailing address
1011 14TH Ave NW
Ardmore, OK 73401-1828
Phone (580) 220-6658
Other providers in Ardmore, OK
- Annette Anderson
- Carmon Anderson
- Daquon C Anderson
- Jordan Anderson
- Molly T Anderson
- Quashonda Anderson
- Whitney Anderson
- Andrean Pittmancounseling PLLC
- Andrea Andres
- Anna C Burson, Inc
All providers in Ardmore, OK · Emergency Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.