Individual provider Active NPI

Manimehalai Vijayan, RN ADVANCE PRACTICE

  • Clinical Nurse Specialist
  • Oklahoma City, OK
National Provider Identifier
1770729907
Registry record updated Oct 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Nurse SpecialistTaxonomy code 364S00000X
License
64359 Issued in OK
Practice address
940 N.E. 13TH Street
Suite 3000
Oklahoma City, OK 73104-5008
Phone
(405) 271-7498
Fax
(405) 271-4328
NPI assigned
Dec 17, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Nurse Specialist 364S00000X 64359 OK Primary

Addresses

Primary practice location

940 N.E. 13TH Street
Suite 3000
Oklahoma City, OK 73104-5008

Mailing address

940 NE 13TH St Ste 3000
Oklahoma City, OK 73104-5008
Phone (405) 271-7498

Other identifiers 1

IdentifierTypeStateIssuer
200281460AMedicaidOK

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
I20100714001027 OK Practitioner - Certified Clinical Nurse Specialist (CNS) 4688706435 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Clinical Nurse Specialist (CNS)
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Absolute Best Care Oklahoma LLCGroup PAC ID 7517329089, 9 clinicians

Practice addresses (Care Compare)

Edmond, OK 73013
Phone (405) 905-1039

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist, Master of Science, Registered Nurse

State licenses

LicenseStateTypeSpecialty
64359OKMDClinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Ou Health Partners, Inc CurrentSince Jul 1, 2021 Accepting new patients
Ou Health Partners, Inc CurrentSince Jul 1, 2021 Accepting new patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Oct 4, 2018 Accepting new patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Oct 4, 2018 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Ou Health Partners, Inc Past Accepting new patients

Locations

1 S Bryant Ave
Edmond, OK 73034
Phone (405) 341-6100

825 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-4864

825 NE 10th St
#2E
Oklahoma City, OK 73104
Phone (405) 271-7001

940 NE 13th St
Ste 3000
Oklahoma City, OK 73104
Phone (405) 271-7498

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1229472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538611200000",
    "number": "1770729907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 NE 13TH ST STE 3000",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045008",
            "telephone_number": "405-271-7498",
            "fax_number": "405-271-4329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 N.E. 13TH STREET",
            "address_2": "SUITE 3000",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045008",
            "telephone_number": "405-271-7498",
            "fax_number": "405-271-4328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIJAYAN",
        "first_name": "MANIMEHALAI",
        "name_prefix": "Mrs.",
        "credential": "RN ADVANCE PRACTICE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-17",
        "last_updated": "2018-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "OK",
            "license": "64359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200281460A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.