Active NPI
Fred M Ingram, D.O.
- Family Medicine Physician
- Collinsville, OK
National Provider Identifier
1699756957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2098
- Practice address
- 1205 W Main St
Collinsville, OK 74021-3114 - Phone
- (918) 371-5885
- Fax
- (918) 371-5986
- NPI assigned
- Nov 14, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2098 | OK | Primary |
| Family Medicine Physician | 207Q00000X | J7525 | TX |
Addresses
Primary practice location
1205 W Main St
Collinsville, OK 74021-3114
Mailing address
1205 W Main St
Collinsville, OK 74021-3114
Phone (918) 371-5885
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080114575 | Other | OK | PALMETTO GBA-RAILROAD |
| 731479823001 | Other | OK | PGBA(TRICARE SOUTH) |
| 731479823 | Other | OK | TRICARE |
| 100106080B | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2098 | OK | MD | Marriage & Family Therapist |
| J7525 | TX | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. John Physicians, Inc | Past | Accepting new patients | |
| St. John Physicians, Inc. | Family Medicine | Past | Accepting new patients |
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.
-
dba Siggins Memorial Clinic
- Rural Health Clinic/Center
- Barnsdall, OK
- NPI 1033176367
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264204800000",
"number": "1699756957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1205 W MAIN ST",
"city": "COLLINSVILLE",
"state": "OK",
"postal_code": "740213114",
"telephone_number": "918-371-5885",
"fax_number": "918-371-5986"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1205 W MAIN ST",
"city": "COLLINSVILLE",
"state": "OK",
"postal_code": "740213114",
"telephone_number": "918-371-5885",
"fax_number": "918-371-5986"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INGRAM",
"first_name": "FRED",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-14",
"last_updated": "2010-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "2098",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "J7525",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA-RAILROAD",
"identifier": "080114575",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PGBA(TRICARE SOUTH)",
"identifier": "731479823001",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "731479823",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100106080B",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Collinsville, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.