NPIMap

Organization Active NPI

Osteopathic Physicians of Tulsa, Inc.

  • Nephrology Physician
  • Tulsa, OK
National Provider Identifier
1487735593
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
3780 Issued in OK
Legal business name
OSTEOPATHIC PHYSICIANS OF TULSA, INC.
Practice address
6465 S Yale Ave Ste 401
Tulsa, OK 74136-7806
Phone
(918) 582-3154
Fax
(918) 582-3593
NPI assigned
Oct 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

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

Authorized official

Name
Tana Cederstrom
Title
Practice Manager
Phone
(918) 748-3383

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X 3780 OK Primary

Addresses

Primary practice location

6465 S Yale Ave Ste 401
Tulsa, OK 74136-7806

Mailing address

6465 S Yale Ave
Ste 401
Tulsa, OK 74136-7823
Phone (918) 582-3154

Other identifiers 1

IdentifierTypeStateIssuer
200034270AMedicaidOK

Other names 1

  • Nephrology Specialists of Tulsa Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040401000449 OK Part B Supplier - Clinic/Group Practice 1850383662 Receives reassigned benefits from 14 practitioners
Practice locations: Claremore, OK; Tulsa, OK

National Provider Directory

National Provider Directory

Locations

6465 S Yale Ave
#401401
Tulsa, OK 74136
Phone 9185823154383

Dept 2761
Tulsa, OK 74182
Phone (918) 582-3154

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739404800000",
    "number": "1487735593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6465 S YALE AVE",
            "address_2": "STE 401",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741367823",
            "telephone_number": "918-582-3154",
            "fax_number": "918-582-3593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6465 S YALE AVE STE 401",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741367806",
            "telephone_number": "918-582-3154",
            "fax_number": "918-582-3593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OSTEOPATHIC PHYSICIANS OF TULSA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A",
        "authorized_official_last_name": "CEDERSTROM",
        "authorized_official_first_name": "TANA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "918-748-3383"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "OK",
            "license": "3780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200034270A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nephrology Specialists of Tulsa",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nephrology Specialists of Tulsa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.