NPIMap

Individual provider Active NPI

Michelle Rene Dawson, PA-C

  • Physician Assistant
  • Oklahoma City, OK
National Provider Identifier
1669838983
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2563 Issued in OK
Practice address
5915 W Memorial Rd Ste 300
Oklahoma City, OK 73142-2022
Phone
(405) 773-6470
NPI assigned
Jan 4, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2563 OK
Physician Assistant 363A00000X 2563 OK Primary

Addresses

Primary practice location

5915 W Memorial Rd Ste 300
Oklahoma City, OK 73142-2022

Mailing address

5915 W Memorial Rd Ste 300
Oklahoma City, OK 73142-2022
Phone (405) 773-6470

Other names 1

  • Michelle Rene Tedder Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, 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
I20160411000497 TX Practitioner - Physician Assistant 2163720095 Reassigns benefits to 1 organization
I20170207002059 OK Practitioner - Physician Assistant 2163720095 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Integris Ambulatory Care CorporationGroup PAC ID 2365408465, 687 clinicians

Practice addresses (Care Compare)

3400 NW Expressway
Suite 500
Oklahoma City, OK 73112-4492
Phone (405) 945-4589

5915 W Memorial Rd
Oklahoma City, OK 73142-2022

Hospital & facility affiliations

  • Integris Baptist Medical Center, Inc Hospital, Oklahoma City, OK, CCN 370028
  • Integris Health Edmond Hospital Hospital, Edmond, OK, CCN 370236
  • Integris Southwest Medical Center Hospital, Oklahoma City, OK, CCN 370106
  • Lakeside Women'S Hospital, a Member of Integris He Hospital, Oklahoma City, OK, CCN 370199

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2563OKMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Choctaw Nation of Oklahoma CurrentSince Feb 8, 2016 Accepting new patients
Choctaw Nation of Oklahoma CurrentSince Feb 8, 2016 Accepting new patients
Integris Ambulatory Care C Orporation Past Accepting new patients

Locations

109 Kerr Ave
Poteau, OK 74953
Phone (918) 647-1199

109 Kerr Blvd
Poteau, OK 74953
Phone (918) 649-1100

1 Choctaw Way
Talihina, OK 74571
Phone (918) 423-8440

Interoperability endpoints

  • Direct secure messaging: mdawson227543@direct.integrisok.com

Organizations & group practices 4

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 9

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": "1451865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1669838983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5915 W MEMORIAL RD STE 300",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731422022",
            "telephone_number": "405-773-6470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5915 W MEMORIAL RD STE 300",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731422022",
            "telephone_number": "405-773-6470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAWSON",
        "first_name": "MICHELLE",
        "middle_name": "RENE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-04",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "2563",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "TEDDER",
            "middle_name": "RENE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.