Active NPI
Paul L. Tennery, M.D.
- Family Medicine Physician
- Oklahoma City, OK
National Provider Identifier
1700812450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 20071
- Practice address
- 1919 E Memorial Rd
Oklahoma City, OK 73131-1253 - Phone
- (405) 341-7009
- Fax
- (405) 330-1811
- NPI assigned
- Jun 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 20071 | OK | Primary |
Addresses
Primary practice location
1919 E Memorial Rd
Oklahoma City, OK 73131-1253
Mailing address
4401 W Memorial Rd
Suite #141; Attn: Terri
Oklahoma City, OK 73134-1785
Phone (405) 936-5800
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20071 | Other | OK | LICENSE |
| 100135900A | Medicaid | OK | |
| 23422 | Other | OK | OBNDD |
| 080149395 | Other | OK | RAILROAD |
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 Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Health Network Inc | Family Medicine | Past | Accepting new patients |
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.
-
- Family Medicine Physician
- Oklahoma City, OK
- NPI 1427097435
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211068800000",
"number": "1700812450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4401 W MEMORIAL RD",
"address_2": "SUITE #141; ATTN: TERRI",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731341785",
"telephone_number": "405-936-5800",
"fax_number": "405-936-5211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1919 E MEMORIAL RD",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731311253",
"telephone_number": "405-341-7009",
"fax_number": "405-330-1811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TENNERY",
"first_name": "PAUL",
"middle_name": "L.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-24",
"last_updated": "2008-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "20071",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "20071",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100135900A",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OBNDD",
"identifier": "23422",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD",
"identifier": "080149395",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.