NPIMap

Organization Active NPI

Shawnee Medical Center Clinic, Inc

Doing business as SSM Health Radiation Oncology Shawnee

  • Radiation Oncology Physician
  • Shawnee, OK
National Provider Identifier
1770178170
Registry record updated Mar 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
SHAWNEE MEDICAL CENTER CLINIC, INC
Doing business as
SSM Health Radiation Oncology Shawnee
Practice address
1102 W Macarthur St
Shawnee, OK 74804-1743
Phone
(405) 272-7311
Fax
(405) 272-6962
NPI assigned
Mar 8, 2021
Last updated
Mar 8, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SSM HEALTH CARE OF OKLAHOMA, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 8, 2021

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

Authorized official

Name
Crystal L Pena
Title
Credentialing Specialist
Phone
(405) 272-7452

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology Physician 207RX0202X NU
Radiation Oncology Physician 2085R0001X NU Primary
Radiation Therapy Radiologic Technologist 2471R0002X NU

Addresses

Primary practice location

1102 W Macarthur St
Shawnee, OK 74804-1743

Mailing address

1102 W Macarthur St
Shawnee, OK 74804-1743
Phone (405) 272-7311

Other names 1

  • SSM Health Radiation Oncology Shawnee Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Shawnee Medical Center Clinic Inc13 organizations share this tax ID, including this one
Part of
St Anthony Hospital Esr

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1615161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615161600000",
    "number": "1770178170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 W MACARTHUR ST",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041743",
            "telephone_number": "405-272-7311",
            "fax_number": "405-272-6962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 W MACARTHUR ST",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041743",
            "telephone_number": "405-272-7311",
            "fax_number": "405-272-6962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWNEE MEDICAL CENTER CLINIC, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM HEALTH CARE OF OKLAHOMA, INC.",
        "enumeration_date": "2021-03-08",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "405-272-7452"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2471R0002X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Radiation Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Radiation Oncology Shawnee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shawnee, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.