NPIMap

Organization Active NPI

Genesis Medical PLLC

Doing business as Southern Oklahoma Pain Management

  • Pain Medicine (Anesthesiology) Physician
  • Oklahoma City, OK
National Provider Identifier
1679471718
Registry record updated Oct 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
GENESIS MEDICAL PLLC
Doing business as
Southern Oklahoma Pain Management
Practice address
1000 W Wilshire Blvd Ste 123a
Oklahoma City, OK 73116-7033
Phone
(580) 221-2022
NPI assigned
Oct 28, 2026
Last updated
Oct 28, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
GENESIS MEDICAL PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 28, 2026

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

Authorized official

Name
Sherry Lynne Clark
Title
Billing/Credentialing
Phone
(580) 223-5180

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X Primary
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X

Addresses

Primary practice location

1000 W Wilshire Blvd Ste 123a
Oklahoma City, OK 73116-7033

Mailing address

2002 12TH Ave NW Ste B
Ardmore, OK 73401-1206

Other names 1

  • Southern Oklahoma Pain Management Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Genesis Medical PLLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1000 W Wilshire Blvd
Ste 123A
Oklahoma City, OK 73116

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1793145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1793145600000",
    "number": "1679471718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 12TH AVE NW STE B",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W WILSHIRE BLVD STE 123A",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731167033",
            "telephone_number": "580-221-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS MEDICAL PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENESIS MEDICAL PLLC",
        "enumeration_date": "2026-10-28",
        "last_updated": "2026-10-28",
        "certification_date": "2026-10-28",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "BILLING/CREDENTIALING",
        "authorized_official_telephone_number": "580-223-5180"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Oklahoma Pain Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.