Derra Bishop

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

110 N 4TH St
Ponca City, OK 74601

Phone

(580) 749-5056

NPI assigned

Jun 8, 2019

Last updated

Jul 8, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grand Lake Mental Health Center, Inc.

  dba GRAND Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Miami, OK
  • NPI 1497762520
  Medicare reassignment
• Grand Lake Mental Health Center Inc

  dba GRAND Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Stillwater, OK
  • NPI 1992341671
  NPD
• Grand Lake Mental Health Center, Inc.

  dba Grand Mental Health

  • Community/Behavioral Health Agency
  • Tulsa, OK
  • NPI 1356048656
  NPD

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

{
    "created_epoch": "1559952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562544000000",
    "number": "1548829054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 N 4TH ST",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746014527",
            "telephone_number": "580-749-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N 4TH ST",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "74601",
            "telephone_number": "580-749-5056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1613 Bradbary Ln",
            "address_purpose": "LOCATION",
            "city": "Ponca City",
            "state": "OK",
            "postal_code": "746012514",
            "country_code": "US",
            "telephone_number": "580-628-1551",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1613 Bradbary Ln",
            "address_purpose": "LOCATION",
            "city": "Ponca City",
            "state": "OK",
            "postal_code": "746012514",
            "country_code": "US",
            "telephone_number": "580-628-1551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BISHOP",
        "first_name": "DERRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-08",
        "last_updated": "2019-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Lee Bierig, APRN-CNP, CNS
• Bintz Pharmacy, Inc. (Bintz Pharmacy)
• Bintz Pharmacy, Inc.
• Gary Dean Bintz, D.PH.
• Kim Leigh Birdsong, LPC
• Cindy Blackwell
• Jacquelynn Blackwell
• Tamara Lynn Blackwell, MBA
• Kimberly Dawn Blagrave
• Blanton Clinic

• Case Manager/Care Coordinator in Ponca City, OK
• Providers in Ponca City, OK by specialty
• Case Manager/Care Coordinator in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2019; 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.