NPIMap

Pavankumar Bommasamudram, M.D.

Individual provider Active NPI Internal Medicine Physician · Tulsa, OK

NPI 1639306293 · NPPES record last updated Dec 5, 2018

Key facts

NPI
1639306293
Entity type
Individual (NPI type 1)
Primary specialty
Internal Medicine Physician 207R00000X
License
27309 (OK)
Practice address
1705 E 19TH St
Ste #302
Tulsa, OK 74104-5405
Phone
(918) 748-7585
Fax
(918) 748-7539
NPI assigned
Jun 22, 2009
Sex
Male
Sole proprietor
No

Organizations & group practices 80

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.

View all 80

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Medicare Care Compare profile

Specialty
Hospitalist
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cherokee Nation (446 clinicians)
Healthfirst Physicians Management Services, Inc. (31 clinicians)
Creek Nation Hospital and Clinics (364 clinicians)
Ahs Oklahoma Physician Group LLC (314 clinicians)
Bryan Medical Center (50 clinicians)
St Bernards Hospital Inc. (187 clinicians)
Good Samaritan Hospital Physician Services, Inc (143 clinicians)

Practice addresses (Care Compare)

100 S Bliss Ave
Tahlequah, OK 74464-2512
Phone (918) 458-3100

1000 N Lee Ave
Oklahoma City, OK 73102-1036
Phone (405) 272-6406

10109 E 79TH St
Tulsa, OK 74133-4564
Phone (918) 756-4333

1120 S Utica Ave
Tulsa, OK 74104-4012
Phone (918) 579-9393

1145 S Utica Ave
Suite 365 Regional Brain Institute
Tulsa, OK 74104-4004
Phone (402) 481-3548

1800 E Coplin St
Okemah, OK 74859-4642
Phone (918) 623-1424

225 E Washington Ave
St Bernards Medical Center
Jonesboro, AR 72401-3119
Phone (870) 972-4100

4687 S Columbia Ave
Pavankumar Bommasamudram M.D.
Tulsa, OK 74105-5129
Phone (402) 481-3548

520 S 7TH St
Vincennes, IN 47591-1038
Phone (812) 885-3280

Hospital & facility affiliations

  • Cherokee Nation W W Hastings Indian Hospital Hospital · Tahlequah, OK · CCN 370171
  • Council Oak Comprehensive Healthcare Hospital · Tulsa, OK · CCN 370244
  • SSM Health St Anthony Hospital - Oklahoma City Hospital · Oklahoma City, OK · CCN 370037
  • Creek Nation Community Hospital Hospital · Okemah, OK · CCN 371333
  • Methodist Jennie Edmundson Hospital · Council Bluffs, IA · CCN 160047

Medicare participation

Medicare fee-for-service enrollment
Enrolled (10 enrollments) in OK, WV, OR, KS, TX, AR, IA, NE, IN, MO
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20120725000093 OK Practitioner - Internal Medicine 3779749478 Reassigns benefits to 11 organizations
I20180821001219 WV Practitioner - Internal Medicine 3779749478 Reassigns benefits to 1 organization
I20180925001867 OR Practitioner - Internal Medicine 3779749478 Reassigns benefits to 1 organization
I20181213001312 KS Practitioner - Internal Medicine 3779749478 Reassigns benefits to 2 organizations
I20190617000508 TX Practitioner - Hospitalist
Practitioner - Internal Medicine		 3779749478 Reassigns benefits to 2 organizations
I20210405000178 AR Practitioner - Internal Medicine 3779749478 Reassigns benefits to 1 organization
I20230622001945 IA Practitioner - Internal Medicine 3779749478 Reassigns benefits to 2 organizations
I20240126000209 NE Practitioner - Internal Medicine 3779749478 Reassigns benefits to 3 organizations
I20240914000436 IN Practitioner - Neurology 3779749478 Reassigns benefits to 1 organization
I20260316003833 MO Practitioner - Internal Medicine 3779749478 Reassigns benefits to 2 organizations

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
28265WVMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Creek Nation Hospital & Clinics Current
since Nov 1, 2019		 Accepting new patients
Jennie Edmundson Memorial Hospital Current
since May 24, 2023		 Accepting new patients
Midwest Hospital Medicine Associates PC Current
since Jul 8, 2017		 Accepting new patients
Creek Nation Hospital & Clinics Current
since Nov 1, 2019		 Accepting new patients
Saunders Medical Center Current Accepting new patients
Saunders Medical Center Current
since Apr 6, 2025		 Accepting new patients
Cedar County Memorial Hospital Current
since Feb 1, 2026		 Accepting new patients
Phillips County Hospital Current Accepting new patients
Cherry County Hospital Current
since Jun 3, 2025		 Accepting new patients
Phillips County Hospital Current
since Mar 21, 2025		 Accepting new patients
Rural Wellness Anadarko Inc Current
since Jul 31, 2023		 Accepting new patients
St. John Physicians, Inc Current
since Jul 30, 2012		 Accepting new patients
Saunders Medical Center Current
since Apr 6, 2025		 Accepting new patients
Creek Nation Hospital & Clinics Internal Medicine Current Accepting new patients
Healthfirst Physicians Management Services, Inc Internal Medicine Current
since Sep 1, 2021		 Accepting new patients
Creek Nation Hospital & Clinics Current
since May 2, 2023		 Accepting new patients
Cherokee Nation Current
since Apr 21, 2019		 Accepting new patients
Brodstone Memorial Hospital Internal Medicine Current
since Jan 20, 2025		 Accepting new patients
Good Samaritan Hospital Current
since Aug 1, 2024		 Accepting new patients
Rural Wellness Fairfax Inc Current
since Jul 15, 2023		 Accepting new patients
Phillips County Hospital Current
since Mar 21, 2025		 Accepting new patients
Howard County Medical Center Current
since Dec 11, 2023		 Accepting new patients
Howard County Medical Center Current
since Dec 11, 2023		 Accepting new patients
Rural Wellness Fairfax Inc Current
since Jul 15, 2023		 Accepting new patients
Bryan Medical Center Current
since Apr 11, 2022		 Accepting new patients
St Bernards Hospital Inc. Current
since Apr 1, 2021		 Accepting new patients
Bryan Medical Center Current
since Apr 11, 2022		 Accepting new patients
Hospitalist Medicine Physicians of Texas, PLLC Internal Medicine Current
since Nov 1, 2019		 Accepting new patients
Cedar County Memorial Hospital Internal Medicine Current
since Feb 1, 2026		 Accepting new patients
Brodstone Memorial Hospital Current
since Jan 20, 2025		 Accepting new patients
Good Samaritan Hospital Physician Services, Inc Internal Medicine Current
since Aug 1, 2024		 Accepting new patients
Cherokee Nation Current Accepting new patients
Rural Physicians Group-Pannu PLLC Internal Medicine Current
since Jul 20, 2018		 Accepting new patients
Rural Wellness Anadarko Inc Current
since Jul 31, 2023		 Accepting new patients
St. John Physicians, Inc. Internal Medicine Current
since Jul 30, 2012		 Accepting new patients
Clarinda Regional Health Center Internal Medicine Current
since Jul 1, 2024		 Accepting new patients
Cherokee Nation Current
since Apr 21, 2019		 Accepting new patients
Butler County Health Care Center Past Accepting new patients
SSM Health Care of Oklahoma, Inc. Past Accepting new patients
Creek Nation Hospital & Clinics Past Accepting new patients
Creek Nation Hospital & Clinics Past Accepting new patients
Cedar County Memorial Hospital Past Accepting new patients
Cherokee Nation Past Accepting new patients
Cedar County Memorial Hospital Past Accepting new patients

Locations (25 of 49)

1201 Fleming Ave
Jonesboro, AR 72401
Phone (870) 932-0440

225 E Washington Ave
Jonesboro, AR 72401
Phone (870) 207-1630

5575 Dtc Pkwy
Ste 225
Greenwood Village, CO 80111

220 Essie Davison Dr
Clarinda, IA 51632
Phone (712) 542-8330

933 E Pierce St
Council Bluffs, IA 51503
Phone (712) 328-6000

520 S 7th St
Vincennes, IN 47591
Phone (812) 885-3280

1160 E Saint Clair St
Vincennes, IN 47591
Phone (812) 882-1064

1150 State St
Phillipsburg, KS 67661
Phone (785) 543-5226

1300 E 5th Ave
Winfield, KS 67156
Phone (620) 221-2300

1140 N State St
Saint Ignace, MI 49781
Phone (906) 643-0466

805 W Cedar St
Standish, MI 48658
Phone (989) 846-3500

1401 S Park St
El Dorado Springs, MO 64744
Phone (417) 876-2511

372 S 9th St
David City, NE 68632
Phone (402) 367-1200

1600 S 48th St
Lincoln, NE 68506
Phone (402) 481-9049

1113 Sherman St
Saint Paul, NE 68873
Phone (308) 754-4421

510 N Green St
Valentine, NE 69201
Phone (402) 376-3770

1760 County Road J
Wahoo, NE 68066
Phone (402) 443-4191

10624 S Eastern Ave
Ste A436
Henderson, NV 89052

1002 E Central Blvd
Anadarko, OK 73005
Phone (405) 247-2551

40 Hospital Rd
Fairfax, OK 74637
Phone (918) 642-8827

859 E Melton Dr
Jay, OK 74346
Phone (918) 253-4271

1 E Clark Bass Blvd
#H
McAlester, OK 74501
Phone (918) 421-6941

1 E Clark Bass Blvd
McAlester, OK 74501
Phone (918) 421-6941

1001 S 41st St E
#3
Muskogee, OK 74403
Phone (918) 687-0201

1020 Lenape Dr
Nowata, OK 74048
Phone (918) 273-0192

Interoperability endpoints

  • Direct secure messaging: pbommasamudram17989@muscogeecreeknation.direct-ci.com
  • FHIR API: https://fhir-myrecord.cerner.com/r4/88f6f0ad-680b-460f-ba7c-9dd496dece04/
  • Direct secure messaging: pbommasamudram208359@ahs.direct-ci.com
  • Direct secure messaging: pavankumar.bommasamudram@direct.stjohnhealthsystem.com
  • FHIR API: https://fhir-myrecord.cerner.com/r4/06e9d567-9657-447f-97fb-d967654387e7/

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 27309 OK Yes
Internal Medicine Physician 207R00000X 04-41542 KS

Addresses

Primary practice location

1705 E 19TH St
Ste #302
Tulsa, OK 74104-5405

Mailing address

1705 E 19TH St
Ste #302
Tulsa, OK 74104
Phone (918) 748-7585

Other providers in Tulsa, OK

All providers in Tulsa, OK · Internal Medicine Physician in Oklahoma

Sources for this page

Verify at the official NPI Registry.