Individual provider Active NPI

Jeremiah Mattox

  • Physician Assistant
  • Norman, OK
National Provider Identifier
1699289686
Registry record updated Nov 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2841 Issued in OK
Practice address
901 N Porter Ave
Norman, OK 73071-6404
Phone
(405) 307-1000
NPI assigned
Nov 29, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2841 OK Primary

Addresses

Primary practice location

901 N Porter Ave
Norman, OK 73071-6404

Mailing address

328 Waterfront Dr
Norman, OK 73071-2147
Phone (405) 740-2363

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180208002445 OK Practitioner - Physician Assistant 8921368150 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Classen Urgent Care Clinic LLCGroup PAC ID 3577737881, 17 clinicians

Practice addresses (Care Compare)

1015 SW 4TH St
Moore, OK 73160-2404
Phone (405) 378-2001

2818 Classen Blvd
Norman, OK 73071-4059
Phone (405) 701-7111

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Classen Urgent Care Clinic LLC CurrentSince Nov 19, 2021 Accepting new patients
Classen Family Practice LLC Past Accepting new patients

Locations

1015 SW 4th St
Moore, OK 73160
Phone (405) 378-2001

2818 Classen Blvd
Norman, OK 73071
Phone (405) 701-7111

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 5

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": "1511913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511913600000",
    "number": "1699289686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "328 WATERFRONT DR",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730712147",
            "telephone_number": "405-740-2363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 N PORTER AVE",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730716404",
            "telephone_number": "405-307-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTOX",
        "first_name": "JEREMIAH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-29",
        "last_updated": "2017-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norman, OK

Sources for this page

Verify at the official NPI Registry.