NPIMap

Individual provider Active NPI

Jeanie L. Klabzuba, D.O.

  • Family Medicine Physician
  • Oklahoma City, OK
National Provider Identifier
1699719773
Registry record updated Jun 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4229 Issued in OK
Practice address
5201 W Memorial Rd
Oklahoma City, OK 73142-2016
Phone
(405) 755-4050
Fax
(405) 752-1553
NPI assigned
Jun 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2017

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 4229 OK Primary

Addresses

Primary practice location

5201 W Memorial Rd
Oklahoma City, OK 73142-2016

Mailing address

5201 W Memorial Road
Oklahoma City, OK 73142-2004
Phone (405) 755-4050

Other identifiers 3

IdentifierTypeStateIssuer
200070030AMedicaidOK
33605OtherOKOBNDD
4229OtherOKLICENSE

Other names 1

  • Jeanie L. Smith Former name

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
I20060929000110 OK Practitioner - Family Practice 4385665405 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oklahoma State University College of Osteopathic Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Oklahoma CommunitiesGroup PAC ID 1153468921, 645 clinicians

Practice addresses (Care Compare)

18503 N Portland Ave
Edmond, OK 73012-9149
Phone (405) 531-4271

Hospital & facility affiliations

  • Mercy Home Health Home health agency, Oklahoma City, OK, CCN 377048
  • Mercy Hospital Oklahoma City, Inc Hospital, Oklahoma City, OK, CCN 370013
  • O U Medical Center Hospital, Oklahoma City, OK, CCN 370093
  • Integris Baptist Medical Center, Inc Hospital, Oklahoma City, OK, CCN 370028
  • Mercy Hospital Logan County Hospital, Guthrie, OK, CCN 371317

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4229OKMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Logan County Inc CurrentSince Apr 8, 2019 Accepting new patients
Mercy Hospital Logan County, Inc CurrentSince Apr 8, 2019 Accepting new patients
Mercy Clinic Oklahoma Communities Family Medicine CurrentSince Jan 11, 2011 Accepting new patients
Summit Medical Center Past Accepting new patients
Mercy Hospital Oklahoma City, Inc Past Accepting new patients
Mercy Health Network Inc Family Medicine Past Accepting new patients
Mercy Hospital Oklahoma City, Inc Past Accepting new patients

Locations

18503 N Portland Ave
Edmond, OK 73012
Phone (405) 531-4271

200 S Academy Rd
Guthrie, OK 73044
Phone (405) 260-4165

2919 S Division St
Guthrie, OK 73044
Phone (405) 282-6301

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

4345 W Memorial Rd
Ste 110
Oklahoma City, OK 73134
Phone (405) 749-7099

5201 W Memorial Rd
Oklahoma City, OK 73142
Phone (405) 755-4050

8325 NW Expressway
Oklahoma City, OK 73162
Phone (405) 728-8000

Interoperability endpoints

  • Direct secure messaging: jklabzuba17236@directc.mercy.net

Organizations & group practices 7

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.

Hospital & facility affiliations 8

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496707200000",
    "number": "1699719773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 W MEMORIAL ROAD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731422004",
            "telephone_number": "405-755-4050",
            "fax_number": "405-749-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 W MEMORIAL RD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731422016",
            "telephone_number": "405-755-4050",
            "fax_number": "405-752-1553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLABZUBA",
        "first_name": "JEANIE",
        "middle_name": "L.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2017-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "4229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200070030A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OBNDD",
            "identifier": "33605",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "4229",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEANIE",
            "last_name": "SMITH",
            "middle_name": "L.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.