Individual provider Active NPI

Justin R Davis, MD

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Oklahoma City, OK
National Provider Identifier
1629282496
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
44055 Issued in OK
Practice address
1200 Childrens Ave
Oklahoma City, OK 73104-4637
Phone
(405) 271-2429
NPI assigned
May 10, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2012004798 MO
Pediatrics Physician 208000000X 04-35493 KS
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 23806 MS
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X R4957 TX
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 44055 OK Primary

Addresses

Primary practice location

1200 Childrens Ave
Oklahoma City, OK 73104-4637

Mailing address

2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-2195

Other practice location 1

4015 22nd Pl
Lubbock, TX 79410-1119
Phone (806) 725-0030

Other practice location 2

2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-2195

Other identifiers 1

IdentifierTypeStateIssuer
02683804MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OK2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230227002946 TX Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 0749468791 Reassigns benefits to 3 organizations
I20241008001669 OK Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 0749468791 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Emergency Medicine
Education
University of Texas Southwestern Medical School at Dallas, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sound Physicians Emergency Medicine of Texas PLLCGroup PAC ID 9739449802, 112 clinicians

Practice addresses (Care Compare)

4002 24TH St
Lubbock, TX 79410-1894
Phone (806) 725-0000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2012004798MOMDPediatrics Physician
R4957TXMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Services of TX, PLLC CurrentSince Aug 1, 2023 Accepting new patients
Texas Children'S Physician Group Pediatrics CurrentSince Apr 14, 2025 Accepting new patients
Ou Health Partners, Inc CurrentSince Aug 9, 2024 Accepting new patients
Ou Health Partners, Inc CurrentSince Aug 9, 2024 Accepting new patients
Ies ER Oklahoma LLC CurrentSince Dec 6, 2025 Accepting new patients
Sound Physicians Emergency Medicine of Texas PLLC CurrentSince Feb 1, 2025 Accepting new patients
Ou Medicine Inc. Past Accepting new patients
Texas Children'S Hospital Past Accepting new patients
Saint Francis Hospital, Inc. Past Accepting new patients

Locations

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

940 NE 13th St
Oklahoma City, OK 73104
Phone (405) 271-2429

1200 Childrens Ave
Oklahoma City, OK 73104
Phone (405) 271-2429

6161 S Yale Ave
Tulsa, OK 74136
Phone (918) 494-2200

10501 E 91st St
Tulsa, OK 74133
Phone (918) 307-6000

8611 N Mopac Expy
Austin, TX 78759
Phone (713) 816-1250

225 E Parkwood Ave
Friendswood, TX 77546
Phone (281) 549-9400

6701 Fannin St
Houston, TX 77030
Phone (832) 822-1764

1275 Marvin Hancock Dr
Jasper, TX 75951
Phone (409) 384-1951

4015 22nd Pl
Lubbock, TX 79410
Phone (806) 725-0000

4002 24th St
Lubbock, TX 79410
Phone (806) 300-3229

11100 Shadow Creek Pkwy
Pearland, TX 77584
Phone (713) 770-7000

3600 Gates Blvd
Port Arthur, TX 77642
Phone (409) 985-7431

7700 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 575-5564

26306 Kuykendahl Rd
Tomball, TX 77375
Phone (346) 246-7700

6651 Main St
Va Hospital, TX 77030
Phone (832) 826-3000

Organizations & group practices 9

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

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737331200000",
    "number": "1629282496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 CHILDRENS AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731044637",
            "telephone_number": "405-271-2429"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4015 22nd Pl",
            "address_purpose": "LOCATION",
            "city": "Lubbock",
            "state": "TX",
            "postal_code": "794101119",
            "country_code": "US",
            "telephone_number": "806-725-0030",
            "fax_number": "806-725-0015",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2500 N State St",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164500",
            "country_code": "US",
            "telephone_number": "601-984-2195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JUSTIN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2012004798",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KS",
            "license": "04-35493",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "MS",
            "license": "23806",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "TX",
            "license": "R4957",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "OK",
            "license": "44055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02683804",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.