Organization Active NPI

Lesa J Bethel Mulligan MD PC

  • Medical Specialty Clinic/Center
  • Norman, OK
National Provider Identifier
1669506507
Registry record updated May 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
LESA J BETHEL MULLIGAN MD PC
Practice address
1139 36TH Ave NW Ste 100
Norman, OK 73072-4104
Phone
(405) 364-0643
Fax
(405) 364-0502
NPI assigned
Mar 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2025

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

Authorized official

Name
Ms. Ann M Hopkins
Title
Insurance Coordinator
Phone
(405) 364-0643

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

1139 36TH Ave NW Ste 100
Norman, OK 73072-4104

Mailing address

1139 36TH Ave NW Ste 100
Norman, OK 73072-4104
Phone (405) 364-0643

Other identifiers 2

IdentifierTypeStateIssuer
100131240BOtherOKSOONERCARE
100131240BMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070712000310 OK Part B Supplier - Clinic/Group Practice 6608976147 Receives reassigned benefits from 7 practitioners
Practice locations: Norman, OK

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D1027372Lesa J Mulligan MD1139 36TH Ave NW, Norman, OK 73072Provider-performed microscopyJun 27, 2028

National Provider Directory

National Provider Directory

Locations

1139 36th Ave NW
Ste 100
Norman, OK 73072
Phone (405) 217-9997

1139 36th Ave NW
Norman, OK 73072
Phone (405) 364-0643

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747958400000",
    "number": "1669506507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1139 36TH AVE NW STE 100",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730724104",
            "telephone_number": "405-364-0643",
            "fax_number": "405-364-0502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1139 36TH AVE NW STE 100",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730724104",
            "telephone_number": "405-364-0643",
            "fax_number": "405-364-0502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LESA J BETHEL MULLIGAN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A",
        "authorized_official_last_name": "HOPKINS",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "405-364-0643",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOONERCARE",
            "identifier": "100131240B",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100131240B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norman, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.