Individual provider Active NPI

Tina Marie Qualls, LCSW

  • Social Worker
  • Okmulgee, OK
National Provider Identifier
1710492558
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Practice address
1401 Morris Dr
Okmulgee, OK 74447-6429
Phone
(918) 758-1910
Fax
(918) 758-1910
NPI assigned
Dec 1, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X OK Primary

Addresses

Primary practice location

1401 Morris Dr
Okmulgee, OK 74447-6429

Mailing address

1401 Morris Dr
Okmulgee, OK 74447-6429
Phone (918) 758-1910

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180314001200 OK Practitioner - Clinical Social Worker 9638431430 Reassigns benefits to 1 organization
I20230803003066 TX Practitioner - Clinical Social Worker 9638431430 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Creek Nation Hospital and ClinicsGroup PAC ID 5698786226, 364 clinicians

Practice addresses (Care Compare)

10109 E 79TH St
Tulsa, OK 74133-4564
Phone (918) 756-4333

1313 E 20TH St
Okmulgee Indian Health Center
Okmulgee, OK 74447-6303
Phone (918) 591-5700

Merit-based Incentive Payment System (MIPS)

Final score
85.12 of 100Reported as group
Quality
83.76
Promoting interoperability
100
Improvement activities
40
Cost
56.64

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Creek Nation Hospital & Clinics Current Accepting new patients
Cherokee Nation Current Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Apr 7, 2023 Accepting new patients
Cherokee Nation CurrentSince Jan 1, 2024 Accepting new patients
Cherokee Nation CurrentSince Jan 1, 2024 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Aug 2, 2023 Accepting new patients

Locations

859 E Melton Dr
Jay, OK 74346
Phone (918) 253-4271

1001 S 41st St E
#3
Muskogee, OK 74403
Phone (918) 687-0201

1020 Lenape Dr
Nowata, OK 74048
Phone (918) 273-0192

1401 Morris Dr
Okmulgee, OK 74447
Phone (918) 456-0641

900 E Airport Rd
Okmulgee, OK 74447
Phone 91875643334448

900 N Owen Walters Blvd
Salina, OK 74365
Phone (918) 434-8500

1125 E Cleveland Ave
Sapulpa, OK 74066
Phone (918) 224-9310

100 S Bliss Ave
Tahlequah, OK 74464
Phone (918) 458-3100

Dept 1467
Tulsa, OK 74182

Dept 1038
Tulsa, OK 74182

10109 E 79th St
Tulsa, OK 74133
Phone (888) 552-6760

Dept 2269
Tulsa, OK 74182

27371 S 4410 Rd
Vinita, OK 74301
Phone (918) 256-4800

Organizations & group practices 6

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": "1512086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1710492558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 MORRIS DR",
            "city": "OKMULGEE",
            "state": "OK",
            "postal_code": "744476429",
            "telephone_number": "918-758-1910",
            "fax_number": "918-756-1270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 MORRIS DR",
            "city": "OKMULGEE",
            "state": "OK",
            "postal_code": "744476429",
            "telephone_number": "918-758-1910",
            "fax_number": "918-758-1910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUALLS",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-01",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Okmulgee, OK

Sources for this page

Verify at the official NPI Registry.