Taelor Baetz, PA
Individual provider Active NPI Physician Assistant · Ponca City, OK
NPI 1881385656 · NPPES record last updated Jul 10, 2024
Key facts
- NPI
- 1881385656
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5266 (OK)
- Practice address
- 415 Fairview Ave Ste 201
Ponca City, OK 74601-1932 - Phone
- (580) 762-9355
- Fax
- (580) 762-9358
- NPI assigned
- May 15, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Integris Ambulatory Care Corporation
Practice addresses (Care Compare)
3400 NW Expressway
Suite 500
Oklahoma City, OK 73112-4492
Phone (405) 945-4589
Hospital & facility affiliations
- Integris Health Ponca City
- Stillwater Medical Center
- Stillwater Medical-Blackwell
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231111000131 | TX | Practitioner - Physician Assistant | 8022465137 | Reassigns benefits to 1 organization |
| I20240702003574 | OK | Practitioner - Physician Assistant | 8022465137 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5266 | OK | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dermatology Associates of Denison PLLC | Current |
Accepting new patients | |
| Integris Ambulatory Care C Orporation | Past | Accepting new patients | |
| Summit Medical Center | Past | Accepting new patients | |
| Integris Health Ponca City Hospital Inc | Past | Accepting new patients |
Locations
5012 US Highway 75
Ste 200
Denison, TX 75020
Phone (903) 463-2223
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/GCFCCA
- tbaetz490381@direct.integrisok.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5266 | OK | Yes |
Addresses
Primary practice location
415 Fairview Ave Ste 201
Ponca City, OK 74601-1932
Mailing address
3001 Quail Springs Pkwy FL 5
Oklahoma City, OK 73134-2640
Phone (580) 762-9355
Other providers in Ponca City, OK
- Craig Vincent Archer
- Amanda Arie
- Surat Attaphitaya
- Avenue of Hope Assoc.
- Rachael Ann Backus
- Mary E Bahruth-Poskey
- Lionel Everett Bair II
- Elizabeth Bales
- Lindsey Renee Bales
- Shayla Barber
All providers in Ponca City, OK · Physician Assistant in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.