Stillwater Radiology LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

STILLWATER RADIOLOGY LLC

Practice address

4721 W 6TH Avenue
Suite 130
Stillwater, OK 74074-1549

Phone

(405) 743-0550

Fax

(405) 743-1704

NPI assigned

Feb 20, 2007

Last updated

Aug 12, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Deanna Southwell

Title

Business Manager

Phone

(405) 743-0550

Specialties & licenses 1

Addresses

Other names 1

• Stillwater Radiology LLC Other name

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 5

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.

• Jeremy Theisen, MD

  • Diagnostic Radiology Physician
  • Ponca City, OK
  • NPI 1881954501
  Medicare reassignment Care Compare group NPD
• Amy B Kirby, MD

  • Diagnostic Radiology Physician
  • Reston, VA
  • NPI 1588616783

  OK

  Medicare reassignment Care Compare group NPD
• James A. Waltermire, M.D.

  • Diagnostic Radiology Physician
  • Stillwater, OK
  • NPI 1194708545
  NPD
• James D Bullen, M.D.

  • Diagnostic Radiology Physician
  • Stillwater, OK
  • NPI 1366424160
  NPD (past)
• Laura K Jacobson, M.D.

  • Diagnostic Radiology Physician
  • Eden Prairie, MN
  • NPI 1932176047
  NPD (past)

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754956800000",
    "number": "1609911452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4721 W 6TH AVENUE",
            "address_2": "SUITE 130",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740741549",
            "telephone_number": "405-743-0550",
            "fax_number": "405-743-1704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4721 W 6TH AVENUE",
            "address_2": "SUITE 130",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740741549",
            "telephone_number": "405-743-0550",
            "fax_number": "405-743-1704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILLWATER RADIOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A",
        "authorized_official_last_name": "SOUTHWELL",
        "authorized_official_first_name": "DEANNA",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "405-743-0550"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stillwater Radiology LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Stillwater Nursing Center LLC (Grace Living Center - Stillwater)
• Stillwater Ophthalmology and Retina, PLLC
• Stillwater Orthopaedic Clinic Inc.
• Stillwater Physical Therapy Center
• Stillwater Public Schools
• Stillwater Skin & Cancer Medical Clinic, Inc
• Stillwater Speech-Language Services
• Stillwater Sports Medicine, Inc. (Stillwater Orthopedic and Sports Medicine Associates)
• Stillwater Surgery Center, LLC
• Stillwater Therapy Solutions

• Diagnostic Radiology Physician in Stillwater, OK
• Providers in Stillwater, OK by specialty
• Diagnostic Radiology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.