Individual provider Active NPI

Michelle Diane Rivera

  • Acute Care Nurse Practitioner
  • Tulsa, OK
National Provider Identifier
1720614373
Registry record updated Aug 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
113676 Issued in OK
Practice address
1705 E 19TH St Ste 302
Tulsa, OK 74104-5410
Phone
(918) 748-7585
Fax
(918) 403-6352
NPI assigned
Mar 16, 2020
Last updated
Aug 4, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 113676 OK Primary
Gerontology Nurse Practitioner 363LG0600X 113676 OK

Addresses

Primary practice location

1705 E 19TH St Ste 302
Tulsa, OK 74104-5410

Mailing address

1705 E 19TH St Ste 302
Tulsa, OK 74104-5410
Phone (918) 748-7585

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200908000750 OK Practitioner - Nurse Practitioner 2567889553 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Usacs Observation Medicine Services of Oklahoma, LLCGroup PAC ID 9931562956, 203 clinicians

Practice addresses (Care Compare)

1923 S Utica Ave
Tulsa, OK 74104-6520
Phone (918) 744-3131

300 Rockefeller Dr
Muskogee, OK 74401-5075
Phone (918) 684-2101

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
113676OKMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc CurrentSince Aug 9, 2020 Accepting new patients
Usacs Critical Care Medicine of Oklahoma, LLC CurrentSince Nov 5, 2024 Accepting new patients
Usacs Observation Medicine Services of Oklahoma, LLC CurrentSince Oct 10, 2024 Accepting new patients
St. John Physicians, Inc. CurrentSince Aug 9, 2020 Accepting new patients
Hospitalist Medicine Physicians of Texas, PLLC CurrentSince Dec 1, 2021 Accepting new patients
Cogent Healthcare of Texas, PA CurrentSince Dec 1, 2021 Accepting new patients
St John Medical Center Inc Past Accepting new patients

Locations

1000 W Boise Cir
Broken Arrow, OK 74012
Phone (918) 994-8000

300 Rockefeller Dr
Muskogee, OK 74401
Phone (918) 682-5501

1000 N Lee Ave
Oklahoma City, OK 73102
Phone (405) 272-6152

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

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345

6161 S Yale Ave
Tulsa, OK 74136
Phone (918) 494-2200

Organizations & group practices 7

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 2

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": "1584316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596499200000",
    "number": "1720614373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 E 19TH ST STE 302",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045410",
            "telephone_number": "918-748-7585",
            "fax_number": "918-403-6352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 E 19TH ST STE 302",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045410",
            "telephone_number": "918-748-7585",
            "fax_number": "918-403-6352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "MICHELLE",
        "middle_name": "DIANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-16",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OK",
            "license": "113676",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OK",
            "license": "113676",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.