NPIMap

Organization Active NPI

Immediate Care of Oklahoma, LLC

  • Urgent Care Clinic/Center
  • Oklahoma City, OK
National Provider Identifier
1780239202
Registry record updated Aug 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
IMMEDIATE CARE OF OKLAHOMA, LLC
Practice address
10616 U.S. Highway 66
Suite 100
Oklahoma City, OK 73099
Phone
(405) 600-6869
NPI assigned
Aug 2, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2019

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

Authorized official

Name
Kevin Penwell, D.O.
Title
President/Com
Phone
(405) 600-6869

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

10616 U.S. Highway 66
Suite 100
Oklahoma City, OK 73099

Mailing address

PO Box 720790
Norman, OK 73070-4614
Phone (405) 600-6869

Other identifiers 1

IdentifierTypeStateIssuer
200459760MedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081002000355 OK Part B Supplier - Clinic/Group Practice 2668540774 Receives reassigned benefits from 50 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Choctaw, OK; Edmond, OK; Norman, OK; Oklahoma City, OK; Tecumseh, OK; Yukon, OK

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Immediate Care of Oklahoma LLC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1564704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564704000000",
    "number": "1780239202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 720790",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730704614",
            "telephone_number": "405-600-6869",
            "fax_number": "405-600-6978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10616 U.S. HIGHWAY 66",
            "address_2": "SUITE 100",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73099",
            "telephone_number": "405-600-6869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMEDIATE CARE OF OKLAHOMA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-02",
        "last_updated": "2019-08-02",
        "status": "A",
        "authorized_official_last_name": "PENWELL",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT/COM",
        "authorized_official_telephone_number": "405-600-6869",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200459760",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.