NPIMap

Organization Active NPI

Spectrum Healthcare Solutions, PLLC

  • Geriatric Medicine (Family Medicine) Physician
  • Oklahoma City, OK
National Provider Identifier
1558816850
Registry record updated Feb 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
26716 Issued in OK
Legal business name
SPECTRUM HEALTHCARE SOLUTIONS, PLLC
Practice address
4220 N Classen Blvd Ste a
Oklahoma City, OK 73118-2434
Phone
(405) 769-5749
Fax
(405) 493-8506
NPI assigned
Aug 17, 2016
Last updated
Feb 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2025

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

Authorized official

Name
Michelle Clark
Title
Coo
Phone
(405) 768-5749

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X 26716 OK Primary

Addresses

Primary practice location

4220 N Classen Blvd Ste a
Oklahoma City, OK 73118-2434

Mailing address

PO Box 6276
Norman, OK 73070-6276
Phone (405) 768-5749

Other identifiers 1

IdentifierTypeStateIssuer
193200000XOtherOKTAXONOMY CODE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161104000192 OK Part B Supplier - Clinic/Group Practice 7618255118 Receives reassigned benefits from 65 practitioners
Practice locations: Oklahoma City, OK

National Provider Directory

National Provider Directory

Locations

1501 N 8th St
Noble, OK 73068
Phone (405) 872-7102

4550 N Classen Blvd Ste a
Oklahoma City, OK 73118

Practitioners & affiliated clinicians

Practitioners 65

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.

View all 65

NPI Registry JSON

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

{
    "created_epoch": "1471392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739836800000",
    "number": "1558816850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6276",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730706276",
            "telephone_number": "405-768-5749",
            "fax_number": "405-493-8506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4220 N CLASSEN BLVD STE A",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731182434",
            "telephone_number": "405-769-5749",
            "fax_number": "405-493-8506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEALTHCARE SOLUTIONS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-17",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "405-768-5749"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "OK",
            "license": "26716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY CODE",
            "identifier": "193200000X",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.