Active NPI
Kassidy Desroche
- Student in an Organized Health Care Education/Training Program
- Tulsa, OK
National Provider Identifier
1881368645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1111 W 17TH St
Tulsa, OK 74107-1886 - Phone
- (918) 561-1145
- NPI assigned
- Aug 5, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
1111 W 17TH St
Tulsa, OK 74107-1886
Mailing address
1111 W 17TH St
Tulsa, OK 74107-1886
Medicare participation
Medicare enrollment files- 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: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1650 Main St
Woodward, OK 73801-3046
Phone (580) 254-8600
3433 NW 56TH St
Oklahoma City, OK 73112-4430
3433 NW 56TH St
Suite 760
Oklahoma City, OK 73112-4461
Phone (405) 951-4345
Hospital & facility affiliations
- Integris Baptist Medical Center, Inc
- Integris Health Woodward Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5199 | OK | MD | Child Abuse Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integris Cardiovsacular Physicians | Past | Accepting new patients |
Interoperability endpoints
- kdesroche321114@direct.integrisok.com
Organizations & group practices 2
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.
-
- Cardiovascular Disease Physician
- Oklahoma City, OK
- NPI 1306129598
-
- Physiological Laboratory
- Oklahoma City, OK
- NPI 1669486858
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Psychiatric Hospital Unit
- Oklahoma City, OK
- NPI 1598837221
-
- Psychiatric Hospital Unit
- Spencer, OK
- NPI 1659443372
-
- General Acute Care Hospital
- Oklahoma City, OK
- NPI 1831103654
-
- Psychiatric Hospital Unit
- Spencer, OK
- NPI 1881760759
-
- General Acute Care Hospital
- Woodward, OK
- NPI 1558148627
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628121600000",
"number": "1881368645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 W 17TH ST",
"city": "TULSA",
"state": "OK",
"postal_code": "741071886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 W 17TH ST",
"city": "TULSA",
"state": "OK",
"postal_code": "741071886",
"telephone_number": "918-561-1145"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESROCHE",
"first_name": "KASSIDY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-05",
"last_updated": "2021-08-05",
"certification_date": "2021-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; 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.