Individual provider Active NPI

Tamara L Bennett-Nolley, PA-C

  • Physician Assistant
  • Tulsa, OK
National Provider Identifier
1598061301
Registry record updated Jul 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1994 Issued in OK
Practice address
10901 E 48TH St
Tulsa, OK 74146-5830
Phone
(918) 749-8765
Fax
(918) 392-2155
NPI assigned
Jan 27, 2011
Last updated
Jul 6, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1994 OK Primary
Surgical Physician Assistant 363AS0400X 1994 OK

Addresses

Primary practice location

10901 E 48TH St
Tulsa, OK 74146-5830

Mailing address

10901 E 48TH St
Tulsa, OK 74146-5830
Phone (918) 749-8765

Other identifiers 1

IdentifierTypeStateIssuer
2003626020AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110314000965 OK Practitioner - Physician Assistant 4981886868 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10901 E 48TH St
Tulsa, OK 74146-5830
Phone (918) 749-8765

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1994OKMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Urologic Specialists of Oklahoma Inc CurrentSince Jun 1, 2021 Accepting new patients
Urologic Specialists of Oklahoma Inc CurrentSince Jun 1, 2021 Accepting new patients
St. John Physicians, Inc. Past Accepting new patients

Locations

10901 E 48th St
Tulsa, OK 74146
Phone (918) 749-8765

Interoperability endpoints

  • Direct secure messaging: tamarabennett@usoinc.medalliesdirect.net

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1296086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657065600000",
    "number": "1598061301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10901 E 48TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741465830",
            "telephone_number": "918-749-8765",
            "fax_number": "918-392-2155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10901 E 48TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741465830",
            "telephone_number": "918-749-8765",
            "fax_number": "918-392-2155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT-NOLLEY",
        "first_name": "TAMARA",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-27",
        "last_updated": "2022-07-06",
        "certification_date": "2022-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1994",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OK",
            "license": "1994",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2003626020A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.