Individual provider Active NPI

Michael W. Flaherty, MD

  • Family Medicine Physician
  • Shattuck, OK
National Provider Identifier
1639177702
Registry record updated Nov 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
14170 Issued in OK
Practice address
905 S Main St
Shattuck, OK 73858-9205
Phone
(580) 938-2551
Fax
(580) 938-2118
NPI assigned
Jul 12, 2005
Last updated
Nov 30, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 14170 OK Primary

Addresses

Primary practice location

905 S Main St
Shattuck, OK 73858-9205

Mailing address

905 S Main St
Shattuck, OK 73858-9205
Phone (580) 938-2551

Other identifiers 1

IdentifierTypeStateIssuer
100089270AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14170OKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Newman Physicians' Group, Inc. Family Medicine CurrentSince Sep 1, 2007 Accepting new patients

Locations

416 S Main St
Shattuck, OK 73858
Phone (405) 938-2551

905 S Main St
Shattuck, OK 73858
Phone (580) 938-2551

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FEDDBA

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259539200000",
    "number": "1639177702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 S MAIN ST",
            "city": "SHATTUCK",
            "state": "OK",
            "postal_code": "738589205",
            "telephone_number": "580-938-2551",
            "fax_number": "580-938-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 S MAIN ST",
            "city": "SHATTUCK",
            "state": "OK",
            "postal_code": "738589205",
            "telephone_number": "580-938-2551",
            "fax_number": "580-938-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLAHERTY",
        "first_name": "MICHAEL",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2009-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "14170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100089270A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shattuck, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.