Individual provider Active NPI

Liz Tomichen

  • Physician Assistant
  • Edmond, OK
National Provider Identifier
1639568942
Registry record updated Jun 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2425 Issued in OK
Practice address
2017 W I 35 Frontage Rd
Suite 170
Edmond, OK 73013-8550
Phone
(405) 757-3365
Fax
(405) 757-3366
NPI assigned
Jan 10, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2425 OK Primary

Addresses

Primary practice location

2017 W I 35 Frontage Rd
Suite 170
Edmond, OK 73013-8550

Mailing address

2017 W I 35 Frontage Rd
Suite 170
Edmond, OK 73013-8550
Phone (405) 757-3365

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150312002017 OK Practitioner - Physician Assistant 7214253012 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2425OKMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc CurrentSince Oct 1, 2015 Accepting new patients
St. John Physicians, Inc. CurrentSince Oct 1, 2015 Accepting new patients
Mercy Hospital Logan County, Inc CurrentSince Jun 20, 2016 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Mercy Hospital Oklahoma City, Inc Past Accepting new patients

Locations

200 S Academy Rd
Guthrie, OK 73044
Phone (405) 260-4165

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345

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

Interoperability endpoints

  • Direct secure messaging: liz.tomichen.1@17630.direct.athenahealth.com

Organizations & group practices 8

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": "1420848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466121600000",
    "number": "1639568942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2017 W I 35 FRONTAGE RD",
            "address_2": "SUITE 170",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730138550",
            "telephone_number": "405-757-3365",
            "fax_number": "405-757-3366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2017 W I 35 FRONTAGE RD",
            "address_2": "SUITE 170",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730138550",
            "telephone_number": "405-757-3365",
            "fax_number": "405-757-3366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOMICHEN",
        "first_name": "LIZ",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-10",
        "last_updated": "2016-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

Verify at the official NPI Registry.