NPIMap

Individual provider Active NPI

Gerald A Amundsen II, MD

  • Family Medicine Physician
  • Mustang, OK
National Provider Identifier
1710989702
Registry record updated May 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20242 Issued in OK
Practice address
206 N Mustang Mall Ter
Mustang, OK 73064-5135
Phone
(405) 256-6000
Fax
(405) 256-6001
NPI assigned
Aug 10, 2005
Last updated
May 23, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20242 OK Primary

Addresses

Primary practice location

206 N Mustang Mall Ter
Mustang, OK 73064-5135

Mailing address

206 N Mustang Mall Ter
Mustang, OK 73064-5135
Phone (405) 256-6000

Other identifiers 2

IdentifierTypeStateIssuer
100204570BMedicaidOK
200018240AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040216001119 OK Practitioner - Family Practice 4880589233 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Oklahoma College of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

206 N Mustang Mall Terrace
Mustang, OK 73064-5135
Phone (405) 256-6000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20242OKMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Mustang Family Physicians PC Family Medicine CurrentSince May 17, 2007 Accepting new patients
Peter Bullock MD PC Family Medicine PastSince Aug 1, 2010 Accepting new patients
Summit Medical Center Past Accepting new patients
Watonga Hospital Trust Authority Past Accepting new patients
Watonga Hospital Trust Authority Past Accepting new patients
Integris Ambulatory Care Corporation Family Medicine Past Accepting new patients
Deaconess Metropolitan Physicians LLC Family Medicine Past Accepting new patients
Western Cpap Supply LLC PastSince Feb 25, 2008 Accepting new patients
Integris Rural Health Inc Family Medicine Past Accepting new patients

Locations

200 S Castlerock Ln
Mustang, OK 73064
Phone (405) 256-0374

200 S Castlerock Ln
Ste 200
Mustang, OK 73064

206 N Mustang Mall Ter
Mustang, OK 73064
Phone (405) 256-6000

Organizations & group practices 10

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 3

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": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337731200000",
    "number": "1710989702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 N MUSTANG MALL TER",
            "city": "MUSTANG",
            "state": "OK",
            "postal_code": "730645135",
            "telephone_number": "405-256-6000",
            "fax_number": "405-256-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 N MUSTANG MALL TER",
            "city": "MUSTANG",
            "state": "OK",
            "postal_code": "730645135",
            "telephone_number": "405-256-6000",
            "fax_number": "405-256-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMUNDSEN",
        "first_name": "GERALD",
        "middle_name": "A",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2012-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "20242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100204570B",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200018240A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mustang, OK

Sources for this page

Verify at the official NPI Registry.