Active NPI
Samuel Spencer Jellison, DO
- Student in an Organized Health Care Education/Training Program
- Tulsa, OK
National Provider Identifier
1891371373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 717 S Houston Ave FL 3
Tulsa, OK 74127-9023 - Phone
- (918) 382-3535
- Fax
- (918) 382-3559
- NPI assigned
- Mar 23, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary | ||
| Neuroradiology Physician | 2085N0700X | 7750 | OK | |
| Diagnostic Radiology Physician | 2085R0202X | 7750 | OK |
Addresses
Primary practice location
717 S Houston Ave FL 3
Tulsa, OK 74127-9023
Mailing address
169 Ashley Avenue
Room 202 Main Hospital, Msc333
Charleston, SC 29425
Phone (843) 792-0337
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Diagnostic Radiology
- Education
- Oklahoma State University College of Osteopathic Medicine, 2021
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1101 S Belmont Ave
Suite 204
Okmulgee, OK 74447-6315
4500 S Garnett Rd
Suite 112
Tulsa, OK 74146-5201
701 Market Dr
Oklahoma City, OK 73114-8133
PO Box
Suite 1577
Durant, OK 74702
PO Box
Suite 251449
Plano, TX 75025-1449
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7750 | OK | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jackson County Memorial Hospital Authority | Past | Accepting new patients |
Interoperability endpoints
- sjellison536224@direct.integrisok.com
Organizations & group practices 7
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.
-
- General Acute Care Hospital
- Altus, OK
- NPI 1093763781
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779408000000",
"number": "1891371373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "169 ASHLEY AVENUE",
"address_2": "ROOM 202 MAIN HOSPITAL, MSC333",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "29425",
"telephone_number": "843-792-0337",
"fax_number": "843-792-9319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "717 S HOUSTON AVE FL 3",
"city": "TULSA",
"state": "OK",
"postal_code": "741279023",
"telephone_number": "918-382-3535",
"fax_number": "918-382-3559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JELLISON",
"first_name": "SAMUEL",
"middle_name": "SPENCER",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-03-23",
"last_updated": "2026-05-22",
"certification_date": "2026-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
},
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "OK",
"license": "7750",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "OK",
"license": "7750",
"primary": false
}
],
"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 May 22, 2026; 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.