NPIMap

Organization Active NPI

Oklahoma Pain Management PLLC

  • Specialist
  • Oklahoma City, OK
National Provider Identifier
1679760912
Registry record updated May 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
OKLAHOMA PAIN MANAGEMENT PLLC
Practice address
3601 NW 138TH St
Ste 200
Oklahoma City, OK 73134-2513
Phone
(405) 242-4100
Fax
(405) 775-9356
NPI assigned
Oct 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2022

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

Authorized official

Name
Justin Ross PorterNPI 1104098961
Title
Owner
Phone
(405) 360-4705

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

3601 NW 138TH St
Ste 200
Oklahoma City, OK 73134-2513

Mailing address

PO Box 108835
Oklahoma City, OK 73101-8835
Phone (405) 775-9350

Other identifiers 2

IdentifierTypeStateIssuer
200123080AMedicaidOK
DG6361OtherOKMEDICARE RR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071130000154 OK Part B Supplier - Clinic/Group Practice 8123117066 Receives reassigned benefits from 9 practitioners
Practice locations: Norman, OK; Oklahoma City, OK; Shawnee, OK; Yukon, OK
O20100930059619 OK DME Supplier - Multi-Specialty - Physician 8123117066 Practice locations: Oklahoma City, OK

National Provider Directory

National Provider Directory

Locations

4023 N Flood Ave
Norman, OK 73069
Phone (405) 242-4100

3200 Quail Springs Pkwy
Ste 100
Oklahoma City, OK 73134
Phone (405) 418-5400

6510 S Western Ave
Ste 215
Oklahoma City, OK 73139
Phone (405) 775-9355

Practitioners & affiliated clinicians

Practitioners 11

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": "1191196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651536000000",
    "number": "1679760912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 108835",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731018835",
            "telephone_number": "405-775-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 NW 138TH ST",
            "address_2": "STE 200",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731342513",
            "telephone_number": "405-242-4100",
            "fax_number": "405-775-9356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OKLAHOMA PAIN MANAGEMENT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-01",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "ROSS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-360-4705"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200123080A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "DG6361",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 May 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.