NPIMap

Individual provider Active NPI

Kishore Vipperla, M.D.

  • Gastroenterology Physician
  • Tulsa, OK
National Provider Identifier
1669663811
Registry record updated May 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
38015 Issued in OK
Practice address
1145 S Utica Ave Ste 701
Tulsa, OK 74104-4019
Phone
(918) 582-6544
NPI assigned
Aug 5, 2007
Last updated
May 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD437549 PA
Gastroenterology Physician 207RG0100X 38015 OK Primary

Addresses

Primary practice location

1145 S Utica Ave Ste 701
Tulsa, OK 74104-4019

Mailing address

1145 S Utica Ave Ste 110
Tulsa, OK 74104-4013
Phone (918) 579-3825

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, OK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090729000399 PA Practitioner - GastroenterologyPractitioner - Internal Medicine 4981757556 Reassigns benefits to 1 organization
I20210611001455 OK Practitioner - Gastroenterology 4981757556 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ahs Oklahoma Physician Group LLCGroup PAC ID 9436122496, 314 clinicians

Practice addresses (Care Compare)

1145 S Utica Ave
Suite 701
Tulsa, OK 74104-4019
Phone (918) 582-6544

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy102
Upper gastrointestinal (GI) endoscopy for acid reflux443

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ahs Oklahoma Physician Group LLC Internal Medicine CurrentSince Jul 1, 2021 Accepting new patients
Ahs Oklahoma Physician Group, LLC CurrentSince Jul 1, 2021 Accepting new patients
Windber Hospital, Inc. Past Accepting new patients
Ahs Hillcrest Medical Center, LLC Past Accepting new patients
Ahs Southcrest Hospital, LLC Past Accepting new patients

Locations

20 E 34th St
Sand Springs, OK 74063
Phone (918) 245-9675

1145 S Utica Ave
Ste 110
Tulsa, OK 74104
Phone (918) 579-3825

1145 S Utica Ave
Ste 701
Tulsa, OK 74104
Phone (918) 579-0412

Dept 1206
Tulsa, OK 74182

Interoperability endpoints

  • FHIR API: https://epicproxy.ardenthealth.com/fhir/UPC/api/FHIR/R4
  • Direct secure messaging: kvipperla332485@ahs.direct-ci.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1186272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621900800000",
    "number": "1669663811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 S UTICA AVE STE 110",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044013",
            "telephone_number": "918-579-3825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 S UTICA AVE STE 701",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044019",
            "telephone_number": "918-582-6544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIPPERLA",
        "first_name": "KISHORE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-05",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD437549",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OK",
            "license": "38015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.