Larry Shane Elliott
Individual provider Active NPI Family Medicine Physician · Fairview, OK
NPI 1770933277 · NPPES record last updated Mar 23, 2022
Key facts
- NPI
- 1770933277
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 6155 (OK)
- Practice address
- 523 E State Rd
Fairview, OK 73737-1453 - Phone
- (580) 227-3721
- Fax
- (580) 227-2882
- NPI assigned
- Jun 15, 2016
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 9
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Oklahoma State University College of Osteopathic Medicine, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Norman Regional Providers Primary Care
Practice addresses (Care Compare)
2605 SW 119TH St a
Primary Care
Oklahoma City, OK 73170-2601
Phone (405) 912-3400
2605 SW 119TH St B
Chiropractic and Wellness Clinic
Oklahoma City, OK 73170-2601
Phone (405) 912-3900
700 S Telephone Rd
201 Primary Care Moore
Moore, OK 73160-2538
Phone (405) 912-3120
Hospital & facility affiliations
- Norman Regional
- O U Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.91 of 100
- Quality
- 76.55
- Promoting interoperability
- 100
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190820001052 | OK | Practitioner - Family Practice | 1153659875 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairview Regional Medical Center Authority | Current | Accepting new patients | |
| Fairview Regional Medical Center Authority | Family Medicine | Current | Accepting new patients |
| Fairview Regional Medical Center Authority | Family Medicine | Current |
Accepting new patients |
| Fairview Regional Medical Center Authority | Current |
Accepting new patients | |
| Norman Regional Providers Primary Care | Family Medicine | Current |
Accepting new patients |
| Jackson County Memorial Hospital Authority | Past | Accepting new patients | |
| Norman Regional Hospital Authority | Past | Accepting new patients | |
| Jackson County Memorial Hospital Authority | Past | Accepting new patients | |
| Aky MD, LLC | Past | Accepting new patients |
Locations
523 E State Rd
Fairview, OK 73737
Phone (580) 227-1334
700 S Telephone Rd
Ste 201
Moore, OK 73160
Phone (405) 307-5735
2605 SW 119th St
Ste A
Oklahoma City, OK 73170
Phone (405) 912-3100
Interoperability endpoints
- larry.elliott@nrh.eclinicaldirectplus.com
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.973232
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 6155 | OK | Yes |
Addresses
Primary practice location
523 E State Rd
Fairview, OK 73737-1453
Mailing address
523 E State Rd
Fairview, OK 73737-1453
Phone (580) 227-3721
Other providers in Fairview, OK
- Hannah Cook
- County of Major Fairview School Dist 84
- Dentistry for Today, P.C.
- Raegan Dewilde
- Kaci Ranae Edwards
- Entrust DPC PLLC
- Megan Leigh Ewing
- Fairview Family & Sports Chiropractic, P.C.
- Fairview Fellowship Home for Senior Citizens, Inc.
- Fairview Regional Medical Center
All providers in Fairview, OK · Family Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.