Individual provider Active NPI

Ethan Troutt, MD

  • Internal Medicine Physician
  • Oklahoma City, OK
National Provider Identifier
1780178525
Registry record updated Jul 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
33991 Issued in OK
Practice address
4300 W Memorial Rd
Oklahoma City, OK 73120-8304
Phone
(405) 752-3962
Fax
(405) 752-3963
NPI assigned
Jun 15, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 33991 OK Primary

Addresses

Primary practice location

4300 W Memorial Rd
Oklahoma City, OK 73120-8304

Mailing address

4300 W Memorial Rd
Oklahoma City, OK 73120-8304
Phone (405) 752-3962

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL ethan-troutt@ouhsc.edu

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210713003623 OK Practitioner - Internal Medicine 1254733231 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Oklahoma College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Oklahoma CommunitiesGroup PAC ID 1153468921, 645 clinicians

Practice addresses (Care Compare)

4300 W Memorial Rd
Oklahoma City, OK 73120-8304
Phone (405) 755-1515

Hospital & facility affiliations

  • Mercy Hospice Hospice, Oklahoma City, OK, CCN 371509
  • Mercy Hospital Oklahoma City, Inc Hospital, Oklahoma City, OK, CCN 370013
  • Mercy Hospital Ardmore, Inc Hospital, Ardmore, OK, CCN 370047
  • Oklahoma Heart Hospital, LLC Hospital, Oklahoma City, OK, CCN 370215

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
33991OKMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Oklahoma Communities Internal Medicine CurrentSince Aug 1, 2021 Accepting new patients
Mercy Hospital Oklahoma City, Inc Past Accepting new patients

Locations

430 N Monte Vista St
Ada, OK 74820
Phone (580) 226-1251

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

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

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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": "1529020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625702400000",
    "number": "1780178525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 W MEMORIAL RD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731208304",
            "telephone_number": "405-752-3962",
            "fax_number": "405-752-3963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 W MEMORIAL RD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731208304",
            "telephone_number": "405-752-3962",
            "fax_number": "405-752-3963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TROUTT",
        "first_name": "ETHAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-15",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "33991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "ethan-troutt@ouhsc.edu",
            "affiliation": "N",
            "address_1": "700 NE 13th St",
            "city": "Oklahoma City",
            "state": "OK",
            "country_code": "US",
            "postal_code": "731045004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.