NPIMap

Organization Active NPI

Prime Physician Staffing 3 LLC

  • Hospitalist Physician
  • Bartlesville, OK
National Provider Identifier
1831840958
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
PRIME PHYSICIAN STAFFING 3 LLC
Practice address
6006 SE Adams Blvd
Bartlesville, OK 74006-8960
Phone
(918) 331-0550
NPI assigned
Jan 11, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Authorized official

Name
Dr. Jacob Krajicek, DONPI 1154610046
Title
Member
Phone
(918) 576-3150

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

6006 SE Adams Blvd
Bartlesville, OK 74006-8960

Mailing address

20 E 5TH St Ste 620
Tulsa, OK 74103-4441
Phone (918) 576-3150

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220822000333 OK Part B Supplier - Clinic/Group Practice 0446633614 Receives reassigned benefits from 9 practitioners
Practice locations: Bartlesville, OK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1641859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1831840958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 E 5TH ST STE 620",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741034441",
            "telephone_number": "918-576-3150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6006 SE ADAMS BLVD",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740068960",
            "telephone_number": "918-331-0550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME PHYSICIAN STAFFING 3 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-11",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "KRAJICEK",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "918-576-3150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartlesville, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.