NPIMap

Individual provider Active NPI

Ron Mitchlin Gann, D.O.

  • Family Medicine Physician
  • Owasso, OK
National Provider Identifier
1689770760
Registry record updated May 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4408 Issued in OK
Practice address
10512 North 110TH East Avenue
Suite 300
Owasso, OK 74055-6638
Phone
(918) 376-8900
Fax
(918) 376-8990
NPI assigned
Sep 15, 2006
Last updated
May 1, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4408 OK Primary

Addresses

Primary practice location

10512 North 110TH East Avenue
Suite 300
Owasso, OK 74055-6638

Mailing address

10512 North 110TH East Avenue
Suite 300
Owasso, OK 74055-6638
Phone (918) 376-8900

Other identifiers 1

IdentifierTypeStateIssuer
200097630BMedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080804000110 OK Practitioner - Family Practice 7315011715 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oklahoma State University College of Osteopathic Medicine, 2005
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)

10512 N 110TH E Ave
Suite 300
Owasso, OK 74055-6638
Phone (918) 376-8900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions15

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ahs Oklahoma Physician Group LLC Family Medicine CurrentSince Aug 1, 2008 Accepting new patients
Ahs Oklahoma Physician Group, LLC CurrentSince Aug 1, 2008 Accepting new patients
Nowata Nursing Center, Inc. Past Accepting new patients

Locations

10512 N 110th East Ave
Ste 300
Owasso, OK 74055
Phone (918) 272-1172

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

Dept 1206
Tulsa, OK 74182

Interoperability endpoints

  • FHIR API: https://epicproxy.ardenthealth.com/fhir/UPC/api/FHIR/R4
  • Direct secure messaging: rgann112984@ahs.direct-ci.com

Organizations & group practices 3

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 7

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": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398902400000",
    "number": "1689770760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10512 NORTH 110TH EAST AVENUE",
            "address_2": "SUITE 300",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "740556638",
            "telephone_number": "918-376-8900",
            "fax_number": "918-376-8990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10512 NORTH 110TH EAST AVENUE",
            "address_2": "SUITE 300",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "740556638",
            "telephone_number": "918-376-8900",
            "fax_number": "918-376-8990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANN",
        "first_name": "RON",
        "middle_name": "MITCHLIN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2014-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "4408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200097630B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Owasso, OK

Sources for this page

Verify at the official NPI Registry.