Individual provider Active NPI

David M Pagnanelli, MD

  • Neurological Surgery Physician
  • Lawton, OK
National Provider Identifier
1689669905
Registry record updated Jan 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
23774 Issued in OK
Practice address
5604 SW Lee Blvd
Suite 357
Lawton, OK 73505-9681
Phone
(580) 531-4600
Fax
(580) 531-6405
NPI assigned
Sep 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 23774 OK Primary

Addresses

Primary practice location

5604 SW Lee Blvd
Suite 357
Lawton, OK 73505-9681

Mailing address

5604 SW Lee Blvd
Suite 357
Lawton, OK 73505-9681
Phone (580) 531-4600

Other identifiers 1

IdentifierTypeStateIssuer
200035200AMedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040828000001 OK Practitioner - Neurosurgery 5991770489 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southwestern Surgical Affiliates, LLC CurrentSince Jul 1, 2009 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients

Locations

5604 SW Lee Blvd
Ste 357
Lawton, OK 73505
Phone (580) 531-4600

5606 SW Lee Blvd
Ste 205
Lawton, OK 73505
Phone (580) 531-6465

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1821/brand/1/csg/22/fhir/r4

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295827200000",
    "number": "1689669905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5604 SW LEE BLVD",
            "address_2": "SUITE 357",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735059681",
            "telephone_number": "580-531-4600",
            "fax_number": "580-531-6405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5604 SW LEE BLVD",
            "address_2": "SUITE 357",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735059681",
            "telephone_number": "580-531-4600",
            "fax_number": "580-531-6405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAGNANELLI",
        "first_name": "DAVID",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-13",
        "last_updated": "2011-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "OK",
            "license": "23774",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200035200A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

Verify at the official NPI Registry.