NPIMap

Individual provider Active NPI

Dustin Shawn Tedesco, MD

  • Internal Medicine Physician
  • Norman, OK
National Provider Identifier
1649476136
Registry record updated Oct 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25729 Issued in OK
Practice address
1553 N Porter Ave
Norman, OK 73071-6621
Phone
(405) 217-8500
NPI assigned
Jun 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25729 OK Primary

Addresses

Primary practice location

1553 N Porter Ave
Norman, OK 73071-6621

Mailing address

1553 N Porter Ave
Norman, OK 73071-6621
Phone (405) 217-8500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120821000672 OK Practitioner - NephrologyPractitioner - Internal Medicine 7416104708 Reassigns benefits to 2 organizations
Practice locations: Norman, OK

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Norman Regional Providers Specialty CareGroup PAC ID 5496900706, 143 clinicians

Practice addresses (Care Compare)

1553 N Porter Ave
Nephrology Assoc
Norman, OK 73071-6621
Phone (405) 515-0500

Hospital & facility affiliations

  • DaVita Chickasha Dialysis Dialysis facility, Chickasha, OK, CCN 372572
  • DaVita Sooner Dialysis Dialysis facility, Norman, OK, CCN 372562
  • DaVita Anadarko Dialysis Center Dialysis facility, Anadarko, OK, CCN 372575
  • DaVita Moore Dialysis Dialysis facility, Moore, OK, CCN 372603
  • DaVita Cleveland PD Dialysis facility, Oklahoma City, OK, CCN 372579
  • Norman Regional Hospital, Norman, OK, CCN 370008
  • Grady Memorial Hospital Hospital, Chickasha, OK, CCN 370054
  • Purcell Municipal Hospital Hospital, Purcell, OK, CCN 370158
  • Integris Baptist Medical Center, Inc Hospital, Oklahoma City, OK, CCN 370028
  • Arbuckle Memorial Hospital Authority Hospital, Sulphur, OK, CCN 371328

Merit-based Incentive Payment System (MIPS)

Final score
90.91 of 100Reported as apm
Quality
76.55
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25729OKMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grady Memorial Hospital CurrentSince Sep 15, 2014 Accepting new patients
Norman Regional Providers Specialty Care CurrentSince Apr 1, 2019 Accepting new patients
Grady Memorial Hospital CurrentSince Sep 15, 2014 Accepting new patients
Grady Memorial Hospital Current Accepting new patients
Dustin Shaun Tedesco PLLC PastSince Aug 1, 2012 Accepting new patients
Norman Regional Hospital Authority Past Accepting new patients

Locations

2100 W Iowa Ave
Chickasha, OK 73018
Phone (405) 224-2100

2220 W Iowa Ave
Chickasha, OK 73018
Phone (405) 224-2100

901 N Porter Ave
Norman, OK 73071
Phone (405) 307-1500

3300 Healthplex Pkwy
Norman, OK 73072
Phone (405) 329-4102

1553 N Porter Ave
Norman, OK 73071
Phone (405) 217-8500

Interoperability endpoints

  • Direct secure messaging: dustin.tedesco@nrh.eclinicaldirectplus.com

Organizations & group practices 6

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.

Hospital & facility affiliations 12

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

NPI Registry JSON

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

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571702400000",
    "number": "1649476136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1553 N PORTER AVE",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730716621",
            "telephone_number": "405-217-8500",
            "fax_number": "405-217-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1553 N PORTER AVE",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730716621",
            "telephone_number": "405-217-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDESCO",
        "first_name": "DUSTIN",
        "middle_name": "SHAWN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-22",
        "last_updated": "2019-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "25729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norman, OK

Sources for this page

Verify at the official NPI Registry.