Active NPI
Jacob Borgsmiller, DO
- Family Medicine Physician
- Shawnee, OK
National Provider Identifier
1629518295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 6141
- Practice address
- 3315 Kethley Rd
Shawnee, OK 74804-9638 - Phone
- (405) 273-5801
- Fax
- (405) 878-3794
- NPI assigned
- Mar 2, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0124R | OK | |
| Family Medicine Physician | 207Q00000X | 6141 | OK | Primary |
Addresses
Primary practice location
3315 Kethley Rd
Shawnee, OK 74804-9638
Mailing address
3315 Kethley Rd
Shawnee, OK 74804-9638
Phone (405) 273-5801
Other practice location 1
3315 Kethley Rd
Shawnee, OK 74804-9638
Phone (405) 273-5801
Other practice location 2
1600 W University Blvd
Durant, OK 74701-3094
Phone (580) 924-5500
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2749 Progressive Dr
Edmond, OK 73034-7649
Phone (405) 772-4130
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0124R | OK | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saints Medical Group, LLC | Current | Accepting new patients | |
| Saints Medical Group, LLC | Single Specialty | Current | Accepting new patients |
| St Anthony Shawnee Hospital Inc | Past | Accepting new patients | |
| Summit Medical Center | Past | Accepting new patients |
Locations
608 NW 9th St
Ste 2200
Oklahoma City, OK 73102
Phone (405) 231-3737
3700 N Kickapoo Ave
Ste 124
Shawnee, OK 74804
Phone (405) 273-6383
3315 Kethley Rd
Shawnee, OK 74804
Phone (405) 273-5801
Interoperability endpoints
- jborgsmiller152003@direct-ehr-ssmhc.com
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 and National Provider Directory roles.
-
- Family Medicine Physician
- Oklahoma City, OK
- NPI 1437195922
Single Specialty
-
- Durable Medical Equipment & Medical Supplies
- Edmond, OK
- NPI 1730907700
-
- General Acute Care Hospital
- Shawnee, OK
- NPI 1134123193
-
- General Acute Care Hospital
- Edmond, OK
- NPI 1356574560
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Shawnee, OK
- NPI 1851716013
-
- Home Health Agency
- Noble, OK
- NPI 1528169497
-
- General Acute Care Hospital
- Oklahoma City, OK
- NPI 1366545311
-
- General Acute Care Hospital
- Shawnee, OK
- NPI 1134123193
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1488412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602806400000",
"number": "1629518295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3315 KETHLEY RD",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "748049638",
"telephone_number": "405-273-5801",
"fax_number": "405-878-3794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3315 KETHLEY RD",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "748049638",
"telephone_number": "405-273-5801",
"fax_number": "405-878-3794"
}
],
"practiceLocations": [
{
"address_1": "3315 Kethley Rd",
"address_purpose": "LOCATION",
"city": "Shawnee",
"state": "OK",
"postal_code": "748049638",
"country_code": "US",
"telephone_number": "405-273-5801",
"fax_number": "405-878-3794",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1600 W University Blvd",
"address_purpose": "LOCATION",
"city": "Durant",
"state": "OK",
"postal_code": "747013094",
"country_code": "US",
"telephone_number": "580-924-5500",
"fax_number": "580-924-1991",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BORGSMILLER",
"first_name": "JACOB",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-02",
"last_updated": "2020-10-16",
"certification_date": "2020-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "0124R",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "OK",
"license": "6141",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shawnee, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.