NPIMap

Organization Active NPI

St. John Physicians, Inc.

Doing business as SJC Outpatient Diabetes Center

  • Registered Dietitian
  • Tulsa, OK
National Provider Identifier
1528564929
Registry record updated Apr 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
ST. JOHN PHYSICIANS, INC.
Doing business as
SJC Outpatient Diabetes Center
Practice address
1717B S Utica Ave Ste 205
Tulsa, OK 74104-5332
Phone
(918) 744-2444
Fax
(918) 744-2483
NPI assigned
Apr 4, 2018
Last updated
Apr 4, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. JOHN PHYSICIANS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 4, 2018

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

Authorized official

Name
James Bryan Fissel
Title
Director Chief Financial Officer
Phone
(918) 748-7617

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X NU Primary
Registered Nurse 163W00000X NU
Diabetes Educator Registered Nurse 163WD0400X NU

Addresses

Primary practice location

1717B S Utica Ave Ste 205
Tulsa, OK 74104-5332

Mailing address

1923 S Utica Ave # Dt1000
Tulsa, OK 74104-6520
Phone (918) 744-2630

Other names 1

  • SJC Outpatient Diabetes Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Alan Martin MD3 organizations share this tax ID, including this one
Part of
Alan Martin MD

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1923 S Utica Ave
#1000
Tulsa, OK 74104

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1522800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522800000000",
    "number": "1528564929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1923 S UTICA AVE # DT1000",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741046520",
            "telephone_number": "918-744-2630",
            "fax_number": "918-744-2946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717B S UTICA AVE STE 205",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045332",
            "telephone_number": "918-744-2444",
            "fax_number": "918-744-2483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN PHYSICIANS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. JOHN PHYSICIANS, INC.",
        "enumeration_date": "2018-04-04",
        "last_updated": "2018-04-04",
        "status": "A",
        "authorized_official_last_name": "FISSEL",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "BRYAN",
        "authorized_official_title_or_position": "DIRECTOR CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "918-748-7617"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SJC Outpatient Diabetes Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SJC Outpatient Diabetes Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.