Individual provider Active NPI

Stormy Ray Walkup, D.O.

  • Family Medicine Physician
  • Idabel, OK
National Provider Identifier
1710428958
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
6273 Issued in OK
Practice address
1302 S Lynn LN
Idabel, OK 74745-6860
Phone
(580) 286-3993
Fax
(580) 286-3967
NPI assigned
Mar 20, 2017
Last updated
Mar 11, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 6273 OK
Family Medicine Physician 207Q00000X 6273 OK Primary

Addresses

Primary practice location

1302 S Lynn LN
Idabel, OK 74745-6860

Mailing address

1302 S Lynn LN
Idabel, OK 74745-6860
Phone (805) 286-3993

Other practice location 1

1301 E Lincoln Rd
Idabel, OK 74745-7300
Phone (580) 286-7623

Other practice location 2

1600 W University Blvd
Durant, OK 74701-3094
Phone (580) 924-5500

Other identifiers 1

IdentifierTypeStateIssuer
200730970AMedicaidOK

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171006000952 OK Practitioner - Family PracticePractitioner - Hospitalist 6406128594 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oklahoma State University College of Osteopathic Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Walkup Family Medicine Clinic LLCGroup PAC ID 6507279171, 2 clinicians
Elite Integral Staffing LLCGroup PAC ID 0648612341, 15 clinicians

Practice addresses (Care Compare)

1302 S Lynn LN
Idabel, OK 74745-6860
Phone (580) 286-3993

1800 W University Blvd
Durant, OK 74701-3006
Phone (719) 688-1483

901 S 5TH Ave
Madill, OK 73446-3640
Phone (719) 688-1483

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.18 of 100Reported as apm
Quality
71.02
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6273OKMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Durant Hma Physician Management, LLC CurrentSince Sep 18, 2020 Accepting new patients
Walkup Family Medicine Clinic LLC CurrentSince Dec 5, 2020 Accepting new patients
Nes Oklahoma, Inc. Emergency Medicine CurrentSince Oct 31, 2022 Accepting new patients
Elite Integral Staffing LLC Emergency Medicine CurrentSince Apr 1, 2024 Accepting new patients
McCurtain Memorial Medical Management, Inc. Past Accepting new patients
Summit Medical Center Past Accepting new patients
Marshall County Hma, LLC Past Accepting new patients
Durant Hma LLC Past Accepting new patients

Locations

1400 Bryan Dr
Ste 301
Durant, OK 74701
Phone (580) 920-0105

1600 W University Blvd
Durant, OK 74701
Phone (580) 740-0205

1800 W University Blvd
Durant, OK 74701
Phone (580) 924-3080

1302 S Lynn Ln
Idabel, OK 74745
Phone (405) 639-7771

901 S 5th Ave
Madill, OK 73446
Phone (580) 564-7338

1900 N 14th St
Ponca City, OK 74601
Phone (580) 718-2932

105 Wall St
Poteau, OK 74953
Phone (918) 635-3100

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JFHDCD

Organizations & group practices 8

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": "1489968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1710428958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 S LYNN LN",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747456860",
            "telephone_number": "805-286-3993",
            "fax_number": "580-286-3967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 S LYNN LN",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747456860",
            "telephone_number": "580-286-3993",
            "fax_number": "580-286-3967"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 E Lincoln Rd",
            "address_purpose": "LOCATION",
            "city": "Idabel",
            "state": "OK",
            "postal_code": "747457300",
            "country_code": "US",
            "telephone_number": "580-286-7623",
            "fax_number": "580-208-3199",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 W University Blvd",
            "address_purpose": "LOCATION",
            "city": "Durant",
            "state": "OK",
            "postal_code": "747013094",
            "country_code": "US",
            "telephone_number": "580-924-5500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALKUP",
        "first_name": "STORMY",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-20",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "6273",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "6273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200730970A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Idabel, OK

Sources for this page

Verify at the official NPI Registry.