Individual provider Active NPI

Matthew Byron Gibbons

  • Clinical Social Worker
  • Tulsa, OK
National Provider Identifier
1700458098
Registry record updated Mar 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
20254 Issued in OK
Practice address
621 E 4TH St
Tulsa, OK 74120-3017
Phone
(479) 445-8656
NPI assigned
Jul 15, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 6, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 20254 OK Primary

Addresses

Primary practice location

621 E 4TH St
Tulsa, OK 74120-3017

Mailing address

10022 E 29TH St
Tulsa, OK 74129-4409
Phone (479) 445-8656

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260112000404 OK Practitioner - Clinical Social Worker 9931685773 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

620 NW 5TH St
Suite D
Moore, OK 73160-3947

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
20254OKMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Therapy Solutions of Oklahoma, LLC CurrentSince Jan 5, 2026 Accepting new patients

Locations

620 NW 5th St
Ste D
Moore, OK 73160

Organizations & group practices 1

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": "1626307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772755200000",
    "number": "1700458098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10022 E 29TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741294409",
            "telephone_number": "479-445-8656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 E 4TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741203017",
            "telephone_number": "479-445-8656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBBONS",
        "first_name": "MATTHEW",
        "middle_name": "BYRON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-15",
        "last_updated": "2026-03-06",
        "certification_date": "2026-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "20254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.