Connor Blaine Rutherford, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

38079 Issued in OK

Practice address

2307 S Gordon Cooper Dr
Shawnee, OK 74801

Phone

(405) 273-5236

NPI assigned

Jul 9, 2020

Last updated

Aug 27, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Family Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Citizen Potawatomi NationGroup PAC ID 3375511488, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SSM Health St Anthony Hospital - Shawnee Hospital, Shawnee, OK, CCN 370149

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: crutherford200437@direct.integrisok.com
• FHIR API: https://epicproxy.et1447.epichosted.com/APIProxyPRD/api/FHIR/R4

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.

• Citizen Potawatomi Nation

  dba Citizen Potawatomi Nation West Clinic

  • Federally Qualified Health Center (FQHC)
  • Shawnee, OK
  • NPI 1881981744

  TX

  Medicare reassignment Care Compare group NPD
• Citizen Potawatomi Nation

  dba Citizen Potawatomi Nation Clinic

  • Federally Qualified Health Center (FQHC)
  • Shawnee, OK
  • NPI 1194752949
  NPD
• Citizen Potawatomi Nation

  • Chiropractor
  • Shawnee, OK
  • NPI 1427659523
  NPD
• Great Plains Medical Foundation

  dba Great Plains Family Practice

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1285708164
  NPD (past)
• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Anthony Shawnee Hospital Inc

  dba St Anthony Shawnee Hospital

  • General Acute Care Hospital
  • Shawnee, OK
  • NPI 1134123193
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1700404415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2307 S GORDON COOPER DRIVE",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "74801",
            "telephone_number": "405-273-5236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2307 S GORDON COOPER DR",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "74801",
            "telephone_number": "405-273-5236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTHERFORD",
        "first_name": "CONNOR",
        "middle_name": "BLAINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-09",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "38079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn E Ruef
• Rural Area Counseling
• Christy Rushing
• Calyn Cheyenne Russ
• Bailey Dawn Rutherford Gonzales, LPN
• Sabine County Hospital District (Sabine County Hospital)
• Saint Medical Group, LLC (SSM Health Shawnee Ambulatory Care)
• Saint Medical Group, LLC (Family Healthcare Clinic Shawnee)
• Saints Medical Group, LLC (SSM Health Medical Group Shawnee Kickapoo Clinic)
• Saints Medical Group, LLC

• Family Medicine Physician in Shawnee, OK
• Providers in Shawnee, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.