Jacob Austin Ruzicka, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

38921 Issued in OK

Practice address

19646 E 140TH St S
Broken Arrow, OK 74014-4555

Phone

(918) 260-5920

NPI assigned

Mar 22, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

93.51 of 100Reported as group

Quality

84.87

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Emergency Medicine Physicians of Tulsa County, LLC

  • Emergency Medicine Physician
  • Tulsa, OK
  • NPI 1003098773

  Single Specialty

  Medicare reassignment NPD
• Ies ER Oklahoma LLC

  • Emergency Medicine Physician
  • Tulsa, OK
  • NPI 1447148093

  Single Specialty

  Medicare reassignment NPD
• Owasso Medical Facility, Inc

  dba St. John Owasso

  • General Acute Care Hospital
  • Owasso, OK
  • NPI 1144231432
  NPD (past)
• Saint Francis Hospital South LLC

  dba Saint Francis Hospital South

  • General Acute Care Hospital
  • Tulsa, OK
  • NPI 1376561944

  Single Specialty

  NPD (past)
• Saint Francis Hospital Vinita, Inc

  • General Acute Care Hospital
  • Vinita, OK
  • NPI 1700334232

  Single Specialty

  NPD (past)
• Saint Francis Hospital, Inc.

  • General Acute Care Hospital
  • Tulsa, OK
  • NPI 1144228487

  Single Specialty

  NPD (past)
• St John Sapulpa, Inc.

  • Critical Access Hospital
  • Sapulpa, OK
  • NPI 1922076603

  Single Specialty

  NPD (past)
• St. John Broken Arrow, Inc

  dba Ascension St. John Jenks

  • General Acute Care Hospital
  • Broken Arrow, OK
  • NPI 1497988596
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1750841029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 RIVER RIDGE RD",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740144502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19646 E 140TH ST S",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740144555",
            "telephone_number": "918-260-5920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUZICKA",
        "first_name": "JACOB",
        "middle_name": "AUSTIN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-22",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "38921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lyan Russell, PHARMD
• Donna Rust, LCSW
• Caleb Paul Ruth
• Kelsey Rutherford, OTR/L
• Matthew Aaron Ruyle, COTA
• S-Q Home Care Specialties Inc
• S-Q Residential Services
• Kristi Gene Sager, ARNP
• Shawn David Sager, NURSE PRACTITIONER
• Maria Fernanda Salas-Alvarez

• Emergency Medicine Physician in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Emergency Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.