Derek Todd Landis, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

25666 Issued in OK

Practice address

921 14TH Ave NW
Ardmore, OK 73401-1837

Phone

(580) 223-5311

Fax

(580) 223-8227

NPI assigned

Jul 24, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dlandis5136@directc.mercy.net

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.

• Mercy Clinic Oklahoma Communities

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1386874550
  Medicare reassignment NPD
• Mercy Hospital Ardmore, Inc.

  • General Acute Care Hospital
  • Ardmore, OK
  • NPI 1386741635
  NPD (past)
• Mercy Hospital Oklahoma City, Inc

  • Diagnostic Radiology Physician
  • Yukon, OK
  • NPI 1730326406
  NPD (past)
• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400544000000",
    "number": "1487854642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 W MEMORIAL RD",
            "address_2": "SUITE 140",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341785",
            "telephone_number": "405-752-3162",
            "fax_number": "405-936-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 14TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011837",
            "telephone_number": "580-223-5311",
            "fax_number": "580-223-8227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDIS",
        "first_name": "DEREK",
        "middle_name": "TODD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-24",
        "last_updated": "2014-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "25666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OKLAHOMA MEDICAL LICENSE",
            "identifier": "25666",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OBNDD LICENSE",
            "identifier": "36032",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lakeland Manor Inc
• Connie S Lamar, R.N.
• Laura J. Lamb Atchley, MS, LPC, LADC
• Ethan Lambe
• Cameron Paul Lancarte, MD
• Laycee Landis
• Lloyd B Landis, DPM
• Jamie Ryan Lang, LPC
• Stephanie R Lang, PTA
• Jodi Larkin

• Pediatrics Physician in Ardmore, OK
• Providers in Ardmore, OK by specialty
• Pediatrics Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.