Midwest Medical Group PLLC
Organization Active NPI Family Medicine Physician · Midwest City, OK
NPI 1508842444 · NPPES record last updated Dec 11, 2014
Key facts
- NPI
- 1508842444
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MIDWEST MEDICAL GROUP PLLC
- Practice address
- 1201 S Douglas Blvd
Suite J
Midwest City, OK 73130-5239 - Phone
- (405) 739-6840
- Fax
- (405) 732-7149
- NPI assigned
- Dec 22, 2005
- Organization subpart
- No
Authorized official
- Name
- Debbie Anderson
- Title
- Office Manager
- Phone
- (405) 739-6840
Practitioners 9
-
Aubrey A Kavanaugh, M.D.
-
Stacey D Knapp, DO
-
Joshua Scott Smith, M.D.
-
Alfred C Degner, MD
-
Patrick Morgan, M.D.
-
Timothy Brian Jones, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040112000464 | OK | Part B Supplier - Clinic/Group Practice | 2365342672 |
Receives reassigned benefits from 6 practitioners Practice locations: Midwest City, OK |
National Provider Directory
Locations
1201 S Douglas Blvd
Oklahoma City, OK 73130
Phone (405) 739-6840
1201 S Douglas Blvd
Ste J
Oklahoma City, OK 73130
Phone (405) 739-6840
8800 SE 15th St
Oklahoma City, OK 73110
Phone (405) 610-4411
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/ADIBBA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1201 S Douglas Blvd
Suite J
Midwest City, OK 73130-5239
Mailing address
1201 S Douglas Blvd
Suite J
Midwest City, OK 73130-5239
Phone (405) 739-6840
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100700490B | Medicaid | OK | |
| 375659300 | Other | OK | DEPT OF LABOR FECA |
Other providers in Midwest City, OK
- Midwest City Kidney Clinic PLLC
- Midwest City Post Acute & Rehab LLC
- Midwest City Specialists, LLC
- Midwest Dermatology Incorporated PC
- Midwest Hma Home Health, LLC
- Midwest Nephrology Associates PC
- Midwest Nephrology Group PLLC
- Midwest Oncology Group, PLLC
- Midwest Open MRI, LLC
- Midwest Pathology Services
All providers in Midwest City, OK · Family Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.