Clinton R. Childs, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

19517 Issued in OK

Practice address

1130 E Lansing
Broken Arrow, OK 74012

Phone

(918) 258-9990

Fax

(918) 994-4277

NPI assigned

May 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

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

Specialty

Family Practice

Education

University of Texas Medical Branch at Galveston, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bailey Medical Center, LLC Hospital, Owasso, OK, CCN 370228

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/2d405cde-1d8b-4a50-adff-ca7776cd856e/

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.

• Our Family Doctor LLC

  • Family Medicine Physician
  • Owasso, OK
  • NPI 1992537211
  Medicare reassignment NPD Authorized official
• St John Urgent Care Clinics Inc

  • Urgent Care Clinic/Center
  • Tulsa, OK
  • NPI 1003918830
  Medicare reassignment NPD
• Cherokee Nation

  • Multi-Specialty Clinic/Center
  • Tahlequah, OK
  • NPI 1093722324
  NPD (past)
• Northeastern State University College of Optometry

  • Optometrist
  • Tahlequah, OK
  • NPI 1437106333
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bailey Medical Center, LLC

  • General Acute Care Hospital
  • Owasso, OK
  • NPI 1205846037
  Care Compare affiliation

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537920000000",
    "number": "1841245024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 140728",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "74014",
            "telephone_number": "918-258-9990",
            "fax_number": "918-994-4277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 E LANSING",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "74012",
            "telephone_number": "918-258-9990",
            "fax_number": "918-994-4277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILDS",
        "first_name": "CLINTON",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2018-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K3130",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "19517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "047146801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080175359",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "047146802",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8A9711",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zainab Chaudhary
• Elizabeth Danielle Chavez
• Liuyi Chen, MD
• Cherokee Services
• Ashley Maree Chesser, COTA/L
• Mark Chimento, CP, LPO
• Shelby Lynn Choat, M.S., CF-SLP
• Amber Leigh Chong, M.S., CCC-SLP
• Choose Courage Counseling Services PLLC
• Christopher Yan-CHI Chow, MD

• Family Medicine Physician in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.