Edmond Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

21244 Issued in OK

Legal business name

EDMOND PEDIATRICS

Practice address

2109 N Kelly Ave
Edmond, OK 73003-3908

Phone

(405) 513-8880

Fax

(405) 285-5912

NPI assigned

Dec 6, 2012

Organization subpart

No

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

Authorized official

Name

Timothy Fredrick KrousNPI 1851381057

Title

MD

Phone

(405) 381-8600

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

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

• Timothy F Krous, MD

  • Pediatrics Physician
  • Edmond, OK
  • NPI 1851381057
  NPD Authorized official
• Stacey Renee Trupiano, CPNP-PC

  • Pediatric Nurse Practitioner
  • Edmond, OK
  • NPI 1760640106
  NPD
• Timothy J. Fricker, M.D.

  • Pediatrics Physician
  • Keller, TX
  • NPI 1891759023
  NPD
• Betsy Ann Ittickathra, DO

  • Pediatrics Physician
  • Edmond, OK
  • NPI 1396238135
  NPD (past)
• Alisson Nicole Ward, APRN

  • Pediatric Nurse Practitioner
  • Oklahoma City, OK
  • NPI 1558835306
  NPD (past)
• Alexandria Mary Weaver, APRN

  • Family Nurse Practitioner
  • Oklahoma City, OK
  • NPI 1447758362
  NPD (past)

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

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713139200000",
    "number": "1548505258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109 N KELLY AVE",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730033908",
            "telephone_number": "405-513-8880",
            "fax_number": "405-285-5912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 N KELLY AVE",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730033908",
            "telephone_number": "405-513-8880",
            "fax_number": "405-285-5912"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16440 Muirfield Pl",
            "address_purpose": "LOCATION",
            "city": "Edmond",
            "state": "OK",
            "postal_code": "730139161",
            "country_code": "US",
            "telephone_number": "405-513-8880",
            "fax_number": "405-285-5912",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "401 S Coltrane Rd Ste 210",
            "address_purpose": "LOCATION",
            "city": "Edmond",
            "state": "OK",
            "postal_code": "730346720",
            "country_code": "US",
            "telephone_number": "405-513-8880",
            "fax_number": "405-285-5912",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EDMOND PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-06",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A",
        "authorized_official_last_name": "KROUS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "FREDRICK",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "405-381-8600"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "21244",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100208810A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edmond Memory Care, LLC (Autumn Leaves of Edmond)
• Edmond MRI LLC (Renaissance MRI)
• Edmond Optical Shop, Inc.
• Edmond Oral and Maxillofacial Surgery
• Edmond Pediatric and Teen Dentistry
• Edmond Physician Services LLC
• Edmond Podiatry Associates LLC (Central Oklahoma Foot and Ankle Center of Edmond)
• Edmond Premier Drug LLC
• Edmond Primary Care LLC
• Edmond Public Schools

• Pediatrics Physician in Edmond, OK
• Providers in Edmond, OK by specialty
• Pediatrics Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.