Primary Care of Ada, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PRIMARY CARE OF ADA, LLC

Practice address

1705 Cradduck Rd
Ada, OK 74820-9491

Phone

(580) 279-6313

NPI assigned

Jul 20, 2016

Last updated

Dec 23, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Randi Ivy

Title

Credentialing Specialist

Phone

(580) 272-0485

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sommer Leeann Millard, APRN

  • Family Nurse Practitioner
  • Ada, OK
  • NPI 1205478682
  NPD

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

{
    "created_epoch": "1468972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640217600000",
    "number": "1851744312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 CRADDUCK RD STE B",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748209491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 CRADDUCK RD",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748209491",
            "telephone_number": "580-279-6313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE OF ADA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-20",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A",
        "authorized_official_last_name": "IVY",
        "authorized_official_first_name": "RANDI",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "580-272-0485"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacy Carol Prewitt, B.A.
• Angela Kaye Price, MSHR
• Michelle Y. Price, LCSW
• Joshua Priddle, D.O.
• Kourtney A Priest
• Laura Prince
• Providence Service Corporation of Oklahoma (Providence of Oklahoma)
• Providence Service Corporation of Oklahoma
• Pruett's Food, Inc. (Pruett's Food-Pharmacy#10)
• Pruitt Co. of Ada, Inc (Pruitt Care)

• Internal Medicine Physician in Ada, OK
• Providers in Ada, OK by specialty
• Internal Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2021; 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.