NPIMap

Individual provider Active NPI

Camille Catherine Jackson, M.D.

  • Gynecologic Oncology Physician
  • Oklahoma City, OK
National Provider Identifier
1700046943
Registry record updated Jul 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
License
28930 Issued in OK
Practice address
4401 McAuley Blvd Ste 2200
Oklahoma City, OK 73120-8561
Phone
(405) 749-7023
Fax
(405) 749-7025
NPI assigned
Jun 11, 2008
Last updated
Jul 27, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0201X 28930 OK Primary

Addresses

Primary practice location

4401 McAuley Blvd Ste 2200
Oklahoma City, OK 73120-8561

Mailing address

4401 McAuley Blvd Ste 2200
Oklahoma City, OK 73120-8561
Phone (405) 749-7023

Other names 1

  • Camille Catherine Gunderson 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
I20150811005343 OK Practitioner - Gynecological Oncology 7113232711 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gynecological Oncology
Education
Louisiana State University School of Medicine in New Orleans, 2008
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)

4300 McAuley Blvd
Oklahoma City, OK 73120-8302
Phone (405) 936-5455

4300 W Memorial Rd
Oklahoma City, OK 73120-8304
Phone (405) 755-1515

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of the uterus50

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Regents of the University of Oklahoma - Ou Physicians Multi-Specialty CurrentSince Aug 1, 2015 Accepting new patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Aug 1, 2015 Accepting new patients
Mercy Clinic Oklahoma Communities Multi-Specialty CurrentSince Aug 1, 2021 Accepting new patients
Summit Medical Center Past Accepting new patients
Mercy Hospital Oklahoma City, Inc Multi-Specialty PastSince Aug 1, 2021 Accepting new patients
Jackson County Memorial Hospital Authority Multi-Specialty Past Accepting new patients
Mercy Hospital Oklahoma City, Inc Past Accepting new patients

Locations

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

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

825 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-4864

Interoperability endpoints

  • Direct secure messaging: cjackson1176616@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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1213142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1700046943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 MCAULEY BLVD STE 2200",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731208561",
            "telephone_number": "405-749-7023",
            "fax_number": "405-749-7025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 MCAULEY BLVD STE 2200",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731208561",
            "telephone_number": "405-749-7023",
            "fax_number": "405-749-7025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CAMILLE",
        "middle_name": "CATHERINE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-11",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "OK",
            "license": "28930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAMILLE",
            "last_name": "GUNDERSON",
            "middle_name": "CATHERINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.