NPIMap

Individual provider Active NPI

Merlin Joe Kilbury III, M.D.

  • Emergency Medicine Physician
  • Miami, OK
National Provider Identifier
1780752980
Registry record updated Apr 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
9907 Issued in OK
Practice address
200 2ND Ave SW
Miami, OK 74354-6830
Phone
(918) 540-7573
Fax
(918) 540-7590
NPI assigned
Dec 4, 2006
Last updated
Apr 15, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 9907 OK Primary

Addresses

Primary practice location

200 2ND Ave SW
Miami, OK 74354-6830

Mailing address

200 2ND Ave SW
Miami, OK 74354-6830
Phone (918) 540-7573

Other identifiers 3

IdentifierTypeStateIssuer
100699440MMedicaidOK
100073730AMedicaidOK
200059690AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Healthcare of Oklahoma Emergency Medicine Past Accepting new patients
Mayes County Hma, LLC Past Accepting new patients
Integris Baptist Regional Health Center Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239753600000",
    "number": "1780752980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 2ND AVE SW",
            "city": "MIAMI",
            "state": "OK",
            "postal_code": "743546830",
            "telephone_number": "918-540-7573",
            "fax_number": "918-540-7590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 2ND AVE SW",
            "city": "MIAMI",
            "state": "OK",
            "postal_code": "743546830",
            "telephone_number": "918-540-7573",
            "fax_number": "918-540-7590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILBURY",
        "first_name": "MERLIN",
        "middle_name": "JOE",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-04",
        "last_updated": "2009-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "9907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100699440M",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100073730A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200059690A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2009; 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.