NPIMap

Organization Active NPI

Newborn Specialists of Tulsa, P.C.

  • Neonatal-Perinatal Medicine Physician
  • Tulsa, OK
National Provider Identifier
1497793335
Registry record updated Nov 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
Legal business name
NEWBORN SPECIALISTS OF TULSA, P.C.
Practice address
1120 S Utica Ave
Suite 2123
Tulsa, OK 74104-4012
Phone
(918) 579-5402
Fax
(918) 579-5404
NPI assigned
Jun 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2011

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

Authorized official

Name
Rose Wyrick, CAPPM
Title
Office Manager
Phone
(918) 579-5402

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080N0001X Primary

Addresses

Primary practice location

1120 S Utica Ave
Suite 2123
Tulsa, OK 74104-4012

Mailing address

1120 S Utica Ave
Suite 2123
Tulsa, OK 74104-4012
Phone (918) 579-5402

Other identifiers 4

IdentifierTypeStateIssuer
100748110AMedicaidOK
160476101MedicaidTX
500871405MedicaidMO
154786002MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070314000219 OK Part B Supplier - Clinic/Group Practice 6709989692 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
Practice locations: Tulsa, OK

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1120 S Utica Ave
Ste 2123
Tulsa, OK 74104
Phone (918) 579-5402

1805 E 15th St
Tulsa, OK 74104
Phone (918) 579-5402

1120 S Utica Ave
#2123
Tulsa, OK 74104

5840 S Memorial Dr
Ste 302
Tulsa, OK 74145
Phone (918) 505-2511

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321401600000",
    "number": "1497793335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 S UTICA AVE",
            "address_2": "SUITE 2123",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044012",
            "telephone_number": "918-579-5402",
            "fax_number": "918-579-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 S UTICA AVE",
            "address_2": "SUITE 2123",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044012",
            "telephone_number": "918-579-5402",
            "fax_number": "918-579-5404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWBORN SPECIALISTS OF TULSA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2011-11-16",
        "status": "A",
        "authorized_official_last_name": "WYRICK",
        "authorized_official_first_name": "ROSE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "918-579-5402",
        "authorized_official_credential": "CAPPM"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100748110A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160476101",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500871405",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154786002",
            "state": "AR"
        }
    ],
    "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 Nov 16, 2011; 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.