Kyle C Wooderson, D.O.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

4824 Issued in OK

Practice address

601 E 13TH St
Ste H
Grove, OK 74344-2989

Phone

(918) 786-7300

Fax

(918) 786-7303

NPI assigned

Jul 7, 2009

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

Specialty

General SurgeryAlso: Internal Medicine, Osteopathic Manipulative Medicine

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integris Ambulatory Care CorporationGroup PAC ID 2365408465, 687 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Integris Grove Hospital Hospital, Grove, OK, CCN 370113
• Integris Miami Hospital Hospital, Miami, OK, CCN 370004

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kwooderson12872@direct.integrisok.com

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.

• Integris Ambulatory Care Corporation

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1750333936
  Medicare reassignment Care Compare group
• Mercy Clinic Oklahoma Communities

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1386874550
  Medicare reassignment NPD
• Oklahoma Emergency Physician Partners PLLC

  • Emergency Medicine Physician
  • Durant, OK
  • NPI 1891039764
  NPD
• Integris Ambulatory Care C Orporation

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1326076027
  NPD (past)
• Integris Grove Hospital

  • General Acute Care Hospital
  • Grove, OK
  • NPI 1467473579
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Integris Grove Hospital

  • General Acute Care Hospital
  • Grove, OK
  • NPI 1467473579
  Care Compare affiliation
• Integris Grove Hospital

  • Ambulance
  • Grove, OK
  • NPI 1770626608

  Hospital

  Care Compare affiliation
• Integris Miami Hospital

  • General Acute Care Hospital
  • Miami, OK
  • NPI 1114931342
  Care Compare affiliation
• Integris Miami Hospital

  • Ambulance
  • Miami, OK
  • NPI 1861534786

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1246924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491350400000",
    "number": "1508095977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 N INDEPENDENCE AVE",
            "address_2": "280",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731125556",
            "telephone_number": "918-786-7300",
            "fax_number": "918-786-7303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E 13TH ST",
            "address_2": "STE H",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "743442989",
            "telephone_number": "918-786-7300",
            "fax_number": "918-786-7303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODERSON",
        "first_name": "KYLE",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-07",
        "last_updated": "2017-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OK",
            "license": "4824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200254780A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200505990O",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Staci Michelle Williams
• Amanda Kay Wills
• Megan Wilmering
• Kelsey R Wisdom, M.S., CCC-SLP
• Jaquelynn Jean Wood
• Nichole Marie Wooton
• Burness R Yandell, OD
• Yco, Inc
• Brandon Yeager
• Katie Young

• Surgery Physician in Grove, OK
• Providers in Grove, OK by specialty
• Surgery Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.