NPIMap

Individual provider Active NPI

Penni Cartlidge, APRN-CNP

  • Family Nurse Practitioner
  • Ada, OK
National Provider Identifier
1740644970
Registry record updated Feb 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
69691 Issued in OK
Practice address
905 Colony Dr
Ada, OK 74820-2329
Phone
(580) 436-5111
Fax
(580) 453-3157
NPI assigned
Apr 13, 2016
Last updated
Feb 22, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 69691 OK Primary
Student in an Organized Health Care Education/Training Program 390200000X 0069691 OK

Addresses

Primary practice location

905 Colony Dr
Ada, OK 74820-2329

Mailing address

201 N Monte Vista St
Ada, OK 74820-7213
Phone (580) 453-3156

Other names 1

  • Penni Brewer Former name

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
I20160801000647 OK Practitioner - Nurse Practitioner 0840583654 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

905 Colony Dr
Ada, OK 74820-2329
Phone (580) 436-5111

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
69691OKMDFamily Nurse Practitioner
0069691OKMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Central Oklahoma Family Medical Center, Inc CurrentSince May 1, 2022 Accepting new patients
Mercy Clinic Oklahoma Communities CurrentSince Aug 1, 2016 Accepting new patients
Central Oklahoma Family Medical Center Inc CurrentSince May 1, 2022 Accepting new patients
Central Oklahoma Family Medical Center, Inc. Current Accepting new patients
Summit Medical Center Past Accepting new patients
Mercy Hospital Ada, Inc Past Accepting new patients

Locations

1221 Arlington St
Ste B
Ada, OK 74820
Phone (580) 332-4700

807 N Monte Vista St
Ada, OK 74820
Phone (580) 279-6413

905 Colony Dr
Ada, OK 74820
Phone (580) 434-5111

527 W 3rd St
Konawa, OK 74849
Phone (580) 925-3286

527 W 3rd St
Ste A
Konawa, OK 74849

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

Interoperability endpoints

  • Direct secure messaging: pcartlidge491753@directc.mercy.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1460505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677024000000",
    "number": "1740644970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 N MONTE VISTA ST",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748207213",
            "telephone_number": "580-453-3156",
            "fax_number": "580-453-3157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 COLONY DR",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748202329",
            "telephone_number": "580-436-5111",
            "fax_number": "580-453-3157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARTLIDGE",
        "first_name": "PENNI",
        "name_prefix": "Mrs.",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-13",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "69691",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OK",
            "license": "0069691",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PENNI",
            "last_name": "BREWER",
            "credential": "R.N.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ada, OK

Sources for this page

Verify at the official NPI Registry.