NPIMap

Individual provider Active NPI

Kelly M. Humpherys, MD

  • Family Medicine Physician
  • Ramona, OK
National Provider Identifier
1831272319
Registry record updated Oct 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
26599 Issued in OK
Practice address
400 Wyandotte
Ramona, OK 74061-1337
Phone
(918) 536-2104
Fax
(918) 536-2203
NPI assigned
Oct 20, 2006
Last updated
Oct 18, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 26599 OK Primary

Addresses

Primary practice location

400 Wyandotte
Ramona, OK 74061-1337

Mailing address

P.O. Box 420
400 Wyandotte
Ramona, OK 74061-1337
Phone (918) 536-2104

Other identifiers 4

IdentifierTypeStateIssuer
200207550AMedicaidOK
163634001MedicaidAR
206226201MedicaidMO
5N728OtherARAR BLUE SHIELD #

Other names 1

  • Kelly M. Lietz Former name

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
St. John Physicians, Inc PastSince May 10, 2011 Accepting new patients
Mercy Clinic Springfield Communities PastSince Jan 1, 1990 Accepting new patients
Mercy Clinic Springfield Communities PastSince Jan 1, 1990 Accepting new patients
St Johns Clinic Inc PastSince Jan 1, 1990 Accepting new patients

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, 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": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318896000000",
    "number": "1831272319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 420",
            "address_2": "400 WYANDOTTE",
            "city": "RAMONA",
            "state": "OK",
            "postal_code": "740611337",
            "telephone_number": "918-536-2104",
            "fax_number": "918-536-2203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 WYANDOTTE",
            "city": "RAMONA",
            "state": "OK",
            "postal_code": "740611337",
            "telephone_number": "918-536-2104",
            "fax_number": "918-536-2203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMPHERYS",
        "first_name": "KELLY",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-20",
        "last_updated": "2011-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "26599",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200207550A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163634001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206226201",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BLUE SHIELD #",
            "identifier": "5N728",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "LIETZ",
            "middle_name": "M.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ramona, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2011; 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.