Individual provider Active NPI

Lloyd T. Anderson, MD

  • General Practice Physician
  • Sapulpa, OK
National Provider Identifier
1790823458
Registry record updated Jun 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
9511 Issued in OK
Practice address
1021 E Bryan Ave
Sapulpa, OK 74066-4512
Phone
(918) 227-1000
Fax
(918) 403-6314
NPI assigned
Feb 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 9511 OK
General Practice Physician 208D00000X 9511 OK Primary

Addresses

Primary practice location

1021 E Bryan Ave
Sapulpa, OK 74066-4512

Mailing address

1021 E Bryan Ave
Sapulpa, OK 74066-4512
Phone (918) 227-1000

Other identifiers 1

IdentifierTypeStateIssuer
100105090AMedicaidOK

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
I20070503000288 OK Practitioner - General Practice 9234235565 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc. Emergency Medicine CurrentSince Aug 4, 2008 Accepting new patients
Omni Medical Group Inc CurrentSince Jan 12, 2007 Accepting new patients
St. John Physicians, Inc CurrentSince Aug 4, 2008 Accepting new patients
Utica Services Inc Past Accepting new patients

Locations

12455 E 100th St N
Ste 350
Owasso, OK 74055
Phone (918) 274-5510

1021 E Bryan Ave
Sapulpa, OK 74066
Phone (918) 227-1000

1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345

1705 E 19th St
Ste 304
Tulsa, OK 74104
Phone (918) 748-7660

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

Organizations & group practices 4

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": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528934400000",
    "number": "1790823458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 E BRYAN AVE",
            "city": "SAPULPA",
            "state": "OK",
            "postal_code": "740664512",
            "telephone_number": "918-227-1000",
            "fax_number": "918-403-6314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 E BRYAN AVE",
            "city": "SAPULPA",
            "state": "OK",
            "postal_code": "740664512",
            "telephone_number": "918-227-1000",
            "fax_number": "918-403-6314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "LLOYD",
        "middle_name": "T.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-02",
        "last_updated": "2018-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "9511",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "OK",
            "license": "9511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100105090A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sapulpa, OK

Sources for this page

Verify at the official NPI Registry.