Individual provider Active NPI

Justin Tyler Tomlinson, PA-C

  • Physician Assistant
  • Tulsa, OK
National Provider Identifier
1659840643
Registry record updated Feb 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3011 Issued in OK
Practice address
2488 E 81St St Ste 290
Tulsa, OK 74137-4265
Phone
(918) 494-2665
Fax
(918) 927-3201
NPI assigned
Nov 19, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 3011 OK
Physician Assistant 363A00000X 3011 OK Primary

Addresses

Primary practice location

2488 E 81St St Ste 290
Tulsa, OK 74137-4265

Mailing address

2488 E 81St St Ste 290
Tulsa, OK 74137-4265
Phone (918) 927-3226

Other identifiers 1

IdentifierTypeStateIssuer
200817340AMedicaidOK

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
I20190218001748 OK Practitioner - Physician Assistant 1951649953 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Orthopedics of Oklahoma PLLCGroup PAC ID 8426320912, 90 clinicians

Practice addresses (Care Compare)

205 E B St
Jenks, OK 74037-3906
Phone (918) 299-7937

2488 E 81St St
Suite 290
Tulsa, OK 74137-4265
Phone (918) 494-2665

Hospital & facility affiliations

  • Oklahoma Surgical Hospital, LLC Hospital, Tulsa, OK, CCN 370210
  • Ascension St John Broken Arrow Hospital, Broken Arrow, OK, CCN 370235
  • Cherokee Nation W W Hastings Indian Hospital Hospital, Tahlequah, OK, CCN 370171

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3011OKMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Orthopedics of Oklahoma PLLC Surgical CurrentSince Feb 4, 2019 Accepting new patients

Locations

1071 W Blue Starr Dr
Ste 105
Claremore, OK 74017
Phone (918) 283-2992

205 E B St
Jenks, OK 74037
Phone (918) 299-4411

2488 E 81st St
Ste 290
Tulsa, OK 74137
Phone (918) 494-2665

6475 S Yale Ave
Ste 301
Tulsa, OK 74136
Phone (918) 494-9300

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1542585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612656000000",
    "number": "1659840643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2488 E 81ST ST STE 290",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741374265",
            "telephone_number": "918-927-3226",
            "fax_number": "918-927-3193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2488 E 81ST ST STE 290",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741374265",
            "telephone_number": "918-494-2665",
            "fax_number": "918-927-3201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOMLINSON",
        "first_name": "JUSTIN",
        "middle_name": "TYLER",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-19",
        "last_updated": "2021-02-07",
        "certification_date": "2021-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OK",
            "license": "3011",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "3011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200817340A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.