NPIMap

Individual provider Active NPI

Jason R McHenry, P.A.

  • Physician Assistant
  • Broken Bow, OK
National Provider Identifier
1881695948
Registry record updated Apr 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1255 Issued in OK
Practice address
800 N Park Dr
Broken Bow, OK 74728-2146
Phone
(580) 584-7210
Fax
(580) 584-7213
NPI assigned
Aug 10, 2005
Last updated
Apr 14, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1255 OK Primary

Addresses

Primary practice location

800 N Park Dr
Broken Bow, OK 74728-2146

Mailing address

800 N Park Dr
Broken Bow, OK 74728-2146
Phone (580) 584-7210

Other identifiers 1

IdentifierTypeStateIssuer
200015540AMedicaidOK

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mccurtainfamimilymedicalclinic@outlook.com Direct

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
I20040622000101 OK Practitioner - Physician Assistant 4385635564 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McCurtain Family Medical ClinicGroup PAC ID 3476651514, 3 clinicians

Practice addresses (Care Compare)

800 N Park Dr
Broken Bow, OK 74728-2146
Phone (580) 584-7210

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1255OKMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
McCurtain Memorial Medical Management, Inc. Past Accepting new patients
Summit Medical Center Past Accepting new patients
Choctaw Nation of Oklahoma Past Accepting new patients

Organizations & group practices 4

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 7

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": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649894400000",
    "number": "1881695948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 N PARK DR",
            "city": "BROKEN BOW",
            "state": "OK",
            "postal_code": "747282146",
            "telephone_number": "580-584-7210",
            "fax_number": "580-584-7213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 N PARK DR",
            "city": "BROKEN BOW",
            "state": "OK",
            "postal_code": "747282146",
            "telephone_number": "580-584-7210",
            "fax_number": "580-584-7213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCHENRY",
        "first_name": "JASON",
        "middle_name": "R",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200015540A",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mccurtainfamimilymedicalclinic@outlook.com",
            "affiliation": "N",
            "endpointDescription": "secure email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "800 N Park Dr",
            "city": "Broken Bow",
            "state": "OK",
            "country_code": "US",
            "postal_code": "747282146",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Broken Bow, OK

Sources for this page

Verify at the official NPI Registry.