Pavankumar Bommasamudram, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

27309 Issued in 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

Last updated

Dec 5, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK, WV, OR, KS, TX, AR, IA, NE, IN, MO10 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 10

Specialty

Hospitalist

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Cherokee NationGroup PAC ID 5799698742, 446 clinicians

Healthfirst Physicians Management Services, Inc.Group PAC ID 4183674500, 31 clinicians

Creek Nation Hospital and ClinicsGroup PAC ID 5698786226, 364 clinicians

Ahs Oklahoma Physician Group LLCGroup PAC ID 9436122496, 314 clinicians

Bryan Medical CenterGroup PAC ID 4284628652, 50 clinicians

St Bernards Hospital Inc.Group PAC ID 0941105480, 187 clinicians

Good Samaritan Hospital Physician Services, IncGroup PAC ID 3971671330, 143 clinicians

Practice addresses (Care Compare)

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 enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations (25 of 49)

Interoperability endpoints

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

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.

• Cherokee Nation

  • Multi-Specialty Clinic/Center
  • Sallisaw, OK
  • NPI 1780692723

  TX

  Medicare reassignment Care Compare group NPD
• Creek Nation Hospital & Clinics

  dba Creek Nation Community Hospital

  • Family Medicine Physician
  • Okemah, OK
  • NPI 1467053173

  TX

  Medicare reassignment Care Compare group NPD
• Healthfirst Physicians Management Services, Inc

  • Hospitalist Physician
  • Oklahoma City, OK
  • NPI 1891962460

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Bryan Medical Center

  • Counseling Psychologist
  • Lincoln, NE
  • NPI 1497809966

  OK

  Medicare reassignment Care Compare group NPD
• Good Samaritan Hospital Physician Services, Inc

  • Hospitalist Physician
  • Vincennes, IN
  • NPI 1649432071

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• St Bernards Hospital Inc.

  dba St Bernards Medical Center

  • General Acute Care Hospital
  • Jonesboro, AR
  • NPI 1396053096
  Medicare reassignment Care Compare group NPD
• Ahs Oklahoma Physician Group LLC

  dba Utica Park Clinic

  • Family Medicine Physician
  • Tulsa, OK
  • NPI 1235182775
  Medicare reassignment Care Compare group
• Creek Nation Hospital & Clinics

  dba Creek Nation Health System

  • Clinic/Center
  • Muskogee, OK
  • NPI 1366593923

  Internal Medicine

  Medicare reassignment NPD
• Midwest Hospital Medicine Associates PC

  • Hospitalist Physician
  • Grove, OK
  • NPI 1124388855
  Medicare reassignment NPD
• Rural Wellness Anadarko Inc

  • Medical Specialty Clinic/Center
  • Anadarko, OK
  • NPI 1538825120
  Medicare reassignment NPD
• Rural Wellness Fairfax Inc

  dba Rural Wellness Fairfax Hospital

  • Critical Access Hospital
  • Fairfax, OK
  • NPI 1295362564
  Medicare reassignment NPD
• St. John Physicians, Inc.

  • Internal Medicine Physician
  • Tulsa, OK
  • NPI 1336194406
  Medicare reassignment NPD

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

• Cherokee Nation

  • General Acute Care Hospital
  • Tahlequah, OK
  • NPI 1275799645
  Care Compare affiliation
• Cherokee Nation

  • Multi-Specialty Clinic/Center
  • Claremore, OK
  • NPI 1497568968

  Hospital

  Care Compare affiliation
• SSM Health Care of Oklahoma Inc

  dba SSM Health Pharmacy

  • Community/Retail Pharmacy
  • Oklahoma City, OK
  • NPI 1649602293

  Hospital

  Care Compare affiliation
• SSM Health Care of Oklahoma, Inc.

  dba SSM Health St. Anthony Hospital - Oklahoma City

  • General Acute Care Hospital
  • Oklahoma City, OK
  • NPI 1366545311
  Care Compare affiliation
• Jennie Edmundson Memorial Hospital

  dba Methodist Jennie Edmundson

  • General Acute Care Hospital
  • Council Bluffs, IA
  • NPI 1457448755
  Care Compare affiliation

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

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543968000000",
    "number": "1639306293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 E 19TH ST",
            "address_2": "STE #302",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74104",
            "telephone_number": "918-748-7585",
            "fax_number": "918-748-7539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 E 19TH ST",
            "address_2": "STE #302",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045405",
            "telephone_number": "918-748-7585",
            "fax_number": "918-748-7539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMMASAMUDRAM",
        "first_name": "PAVANKUMAR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-22",
        "last_updated": "2018-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "27309",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "04-41542",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shantel Laniece Bolton, APRN
• Angela Dene Bolz, D.O.
• Jonathan Bomar, APRN-CRNA
• Mohammed Mazhar Mohammed Anwar Bombaywala
• Lauren Bomier
• Amy Resultan Bonaobra, P.T.
• Abbagale Bond
• Carly Nicole Bond
• Janet Kay Bond, M.S. LPC
• Shannan Beth Bond, D.O.

• Internal Medicine Physician in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Internal Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2018; 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.

Verify at the official NPI Registry.