NPIMap

Individual provider Active NPI

Indigo Drew Vincent Deberry, MD

  • Family Medicine Physician
  • Moore, OK
National Provider Identifier
1730779901
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
38236 Issued in OK
Practice address
1401 SW 34TH St Ste 200
Moore, OK 73160-3059
Phone
(405) 793-1188
Fax
(405) 793-0492
NPI assigned
Jan 21, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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 38236 OK Primary

Addresses

Primary practice location

1401 SW 34TH St Ste 200
Moore, OK 73160-3059

Mailing address

3001 Quail Springs Pkwy FL 5
Oklahoma City, OK 73134-2640
Phone (405) 793-1188

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
I20240731003199 OK Practitioner - Family Practice 1456898048 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Oklahoma College of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integris Ambulatory Care CorporationGroup PAC ID 2365408465, 687 clinicians

Practice addresses (Care Compare)

1401 SW 34TH St
200 Integris Pain MGMT Moore
Oklahoma City, OK 73160-3059
Phone (405) 945-4359

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
38236OKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Integris Ambulatory Care Corporation Family Medicine CurrentSince Jul 29, 2024 Accepting new patients
Integris South Oklahoma City Hospital Corporation Past Accepting new patients
Integris Ambulatory Care C Orporation Family Medicine Past Accepting new patients

Locations

1401 SW 34th St
Ste 200
Moore, OK 73160
Phone (405) 793-1188

3400 NW Expressway
Ste 500
Oklahoma City, OK 73112
Phone (405) 945-4589

3001 Quail Springs Pkwy
Fl 5
Oklahoma City, OK 73134

Interoperability endpoints

  • Direct secure messaging: ideberry212241@direct.integrisok.com

Organizations & group practices 3

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.

Hospital & facility affiliations 12

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": "1611187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1730779901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 QUAIL SPRINGS PKWY FL 5",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731342640",
            "telephone_number": "405-793-1188",
            "fax_number": "405-793-0492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 SW 34TH ST STE 200",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731603059",
            "telephone_number": "405-793-1188",
            "fax_number": "405-793-0492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBERRY",
        "first_name": "INDIGO",
        "middle_name": "DREW VINCENT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-21",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "38236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moore, OK

Sources for this page

Verify at the official NPI Registry.