NPIMap

Individual provider Active NPI

Gary Fennema, D.O.

  • Emergency Medicine Physician
  • Tulsa, OK
National Provider Identifier
1578003992
Registry record updated Dec 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
6402 Issued in OK
Practice address
744 W 9TH St
Tulsa, OK 74127-9020
Phone
(918) 599-1000
NPI assigned
Mar 4, 2017
Last updated
Dec 17, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 6402 OK Primary

Addresses

Primary practice location

744 W 9TH St
Tulsa, OK 74127-9020

Mailing address

2622 W 112TH PL S
Jenks, OK 74037-2127
Phone (918) 691-4601

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191119003044 OK Practitioner - Emergency Medicine 4981036522 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Oklahoma State University College of Osteopathic Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeastern Health SystemGroup PAC ID 1456255025, 105 clinicians

Practice addresses (Care Compare)

1400 E Downing St
Tahlequah, OK 74464-3324
Phone (918) 456-0641

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.91 of 100Reported as apm
Quality
76.55
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
90.91 of 100Reported as apm
Quality
76.55
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Health System CurrentSince Dec 1, 2022 Accepting new patients
McAlester Regional Health Center Authority CurrentSince Mar 14, 2024 Accepting new patients
Adair County Health Center,Inc. Current Accepting new patients
Creek Nation Hospital & Clinics Current Accepting new patients
Northeastern Health System Emergency Medicine CurrentSince Dec 1, 2022 Accepting new patients
Adair County Health Center, Inc. CurrentSince Jun 14, 2022 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Jan 1, 2020 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Jan 1, 2020 Accepting new patients
Adair County Health Center, Inc. CurrentSince Jun 14, 2022 Accepting new patients
Northeastern Health System Emergency Medicine Past Accepting new patients
Cleveland Area Hospital Holdings, Inc. Past Accepting new patients
Northeastern Health System Past Accepting new patients

Locations

1 E Clark Bass Blvd
McAlester, OK 74501
Phone (918) 421-6941

1401 Morris Dr
Okmulgee, OK 74447
Phone (918) 456-0641

900 E Airport Rd
Okmulgee, OK 74447
Phone 91875643334448

213 E Redwood Ave
Sallisaw, OK 74955
Phone (918) 774-1100

1125 E Cleveland Ave
Sapulpa, OK 74066
Phone (918) 224-9310

1401 W Locust St
Stilwell, OK 74960
Phone (918) 696-3101

1400 E Downing St
Tahlequah, OK 74464
Phone (918) 456-0641

744 W 9th St
Tulsa, OK 74127
Phone (918) 587-2561

Dept 1467
Tulsa, OK 74182

Interoperability endpoints

  • Direct secure messaging: gfennema703178@ahs.direct-ci.com
  • FHIR API: https://fhir-myrecord.cerner.com/r4/932b43fb-c766-413c-a343-640549d20cb3/

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1488585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671235200000",
    "number": "1578003992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2622 W 112TH PL S",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740372127",
            "telephone_number": "918-691-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 W 9TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741279020",
            "telephone_number": "918-599-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENNEMA",
        "first_name": "GARY",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-04",
        "last_updated": "2022-12-17",
        "certification_date": "2022-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "6402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.