NPIMap

Organization Active NPI

Tahlequah Medical Group LLC

  • Family Medicine Physician
  • Tahlequah, OK
National Provider Identifier
1881960771
Registry record updated Jun 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TAHLEQUAH MEDICAL GROUP LLC
Practice address
1400 E Downing St
Tahlequah, OK 74464-3324
Phone
(918) 456-0641
Fax
(918) 453-2341
NPI assigned
Mar 26, 2012
Last updated
Jun 1, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
TAHLEQUAH HOSPITAL AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 1, 2026

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

Authorized official

Name
James Berry
Title
Ceo
Phone
(918) 456-0641

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Obstetrics & Gynecology Physician 207V00000X NU
Surgery Physician 208600000X NU
Urology Physician 208800000X NU

Addresses

Primary practice location

1400 E Downing St
Tahlequah, OK 74464-3324

Mailing address

1400 E Downing St
Tahlequah, OK 74464-3324
Phone (918) 456-0641

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120822000336 OK Part B Supplier - Clinic/Group Practice 4082861349 Receives reassigned benefits from 42 practitioners
Practice locations: Tahlequah, OK; Pryor, OK; Tahleqhah, OK; Okmulgee, OK; Muskogee, OK; Ft Gibson, OK; Stillwell, OK

National Provider Directory

National Provider Directory
Part of
Tahlequah City Hospital

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1323 W Keetoowah St
Tahlequah, OK 74464
Phone (918) 708-3006

1373 E Boone St
Ste 1200
Tahlequah, OK 74464
Phone (918) 431-0665

Practitioners & affiliated clinicians

Practitioners 56

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.

View all 56

NPI Registry JSON

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

{
    "created_epoch": "1332720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780272000000",
    "number": "1881960771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E DOWNING ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643324",
            "telephone_number": "918-456-0641",
            "fax_number": "918-453-2341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E DOWNING ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643324",
            "telephone_number": "918-456-0641",
            "fax_number": "918-453-2341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAHLEQUAH MEDICAL GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TAHLEQUAH HOSPITAL AUTHORITY",
        "enumeration_date": "2012-03-26",
        "last_updated": "2026-06-01",
        "certification_date": "2026-06-01",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-456-0641"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tahlequah, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.