NPIMap

Individual provider Active NPI

Carl Andrew Raczkowski, M.D.

  • Gastroenterology Physician
  • Oklahoma City, OK
National Provider Identifier
1851375646
Registry record updated Aug 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
17684 Issued in OK
Practice address
3366 NW Expressway
Ste 300
Oklahoma City, OK 73112-4462
Phone
(405) 702-1300
Fax
(405) 702-1280
NPI assigned
Dec 5, 2005
Last updated
Aug 10, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 17684 OK Primary

Addresses

Primary practice location

3366 NW Expressway
Ste 300
Oklahoma City, OK 73112-4462

Mailing address

3366 NW Expressway
Ste 300
Oklahoma City, OK 73112-4462
Phone (405) 702-1300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100810000727 OK Practitioner - Gastroenterology 5193782977 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
University of Oklahoma College of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Digestive Disease Specialists IncGroup PAC ID 7315939279, 18 clinicians

Practice addresses (Care Compare)

10029 N Oklahoma Ave
Suite 200
Oklahoma City, OK 73114-7454
Phone (405) 702-1300

707 S Monroe St
Integris Bass Specialty Gastroenterology
Enid, OK 73701-7286
Phone (580) 977-1960

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy187
Upper gastrointestinal (GI) endoscopy for acid reflux211

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Integris Bass Baptist Health Center Current Accepting new patients
Integris Bass Baptist Health Center CurrentSince May 1, 2018 Accepting new patients
Integris Ddsi Endoscopy Centers LLC CurrentSince Feb 1, 2021 Accepting new patients
Integris Bass Baptist Health Center Gastroenterology CurrentSince May 1, 2018 Accepting new patients
Integris Ddsi Endoscopy Centers LLC CurrentSince Feb 1, 2021 Accepting new patients
Integris Bass Baptist Health Center Past Accepting new patients

Locations

158 E Sunset Dr
Ste B
Medford, OK 73759
Phone (580) 395-2319

10029 N Oklahoma Ave
Ste 200
Oklahoma City, OK 73114
Phone (405) 702-1300

3366 NW Expressway St
Ste 400
Oklahoma City, OK 73112
Phone (405) 702-1300

4201 S Western Ave
Oklahoma City, OK 73109
Phone (405) 632-4000

Interoperability endpoints

  • Direct secure messaging: craczkowski19386@direct.integrisok.com

Organizations & group practices 7

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.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312934400000",
    "number": "1851375646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3366 NW EXPRESSWAY",
            "address_2": "STE 300",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731124462",
            "telephone_number": "405-702-1300",
            "fax_number": "405-702-1280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3366 NW EXPRESSWAY",
            "address_2": "STE 300",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731124462",
            "telephone_number": "405-702-1300",
            "fax_number": "405-702-1280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RACZKOWSKI",
        "first_name": "CARL",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2011-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OK",
            "license": "17684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.