Active NPI
Edith Mercedes De Jesus, M.D.
- Specialist
- Tulsa, OK
National Provider Identifier
1497281802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 18702
- Practice address
- 10711 E 11TH St
Suite 1
Tulsa, OK 74128-3200 - Phone
- (918) 261-6493
- Fax
- (918) 583-7205
- NPI assigned
- May 4, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 18702 | OK | Primary |
Addresses
Primary practice location
10711 E 11TH St
Suite 1
Tulsa, OK 74128-3200
Mailing address
10711 E 11TH St Ste 1
Xavier Clinic
Tulsa, OK 74128-3212
Phone (918) 261-6493
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 |
|---|---|---|---|
| 18702 | OK | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493856000000",
"number": "1497281802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10711 E 11TH ST STE 1",
"address_2": "XAVIER CLINIC",
"city": "TULSA",
"state": "OK",
"postal_code": "741283212",
"telephone_number": "918-261-6493",
"fax_number": "918-583-7205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10711 E 11TH ST",
"address_2": "SUITE 1",
"city": "TULSA",
"state": "OK",
"postal_code": "741283200",
"telephone_number": "918-261-6493",
"fax_number": "918-583-7205"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE JESUS",
"first_name": "EDITH",
"middle_name": "MERCEDES",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-05-04",
"last_updated": "2017-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OK",
"license": "18702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 May 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.