NPIMap

Individual provider Active NPI

Mitchell D Coppedge, MD

  • Family Medicine Physician
  • Chickasha, OK
National Provider Identifier
1902887482
Registry record updated Aug 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19462 Issued in OK
Practice address
2100 W Iowa Ave
Suite a
Chickasha, OK 73018-2736
Phone
(405) 224-2100
Fax
(405) 779-2855
NPI assigned
Nov 10, 2005
Last updated
Aug 16, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 19462 OK Primary

Addresses

Primary practice location

2100 W Iowa Ave
Suite a
Chickasha, OK 73018-2736

Mailing address

2100 W Iowa Ave
Suite a
Chickasha, OK 73018-2736
Phone (405) 224-2100

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
I20091218000209 OK Practitioner - Family Practice 6608787205 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas Tech University Health Science Center School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grady Memorial HospitalGroup PAC ID 0648175778, shared by 6 NPIs, 47 clinicians

Practice addresses (Care Compare)

2100 W Iowa Ave
Suite a
Chickasha, OK 73018-2736
Phone (405) 224-2100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.91 of 100Reported as apm
Quality
76.55
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
19462OKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grady Memorial Hospital Family Medicine CurrentSince Jun 1, 2015 Accepting new patients
Grady Memorial Hospital Current Accepting new patients
Grady Memorial Hospital CurrentSince Oct 1, 2013 Accepting new patients
Grady Memorial Hospital Current Accepting new patients
Grady Memorial Hospital Family Medicine CurrentSince Oct 1, 2013 Accepting new patients
Summit Medical Center Past Accepting new patients
Glenhaven Corporation Past Accepting new patients
Chickasha Nursing Center Inc. Past Accepting new patients

Locations

2100 W Iowa Ave
Chickasha, OK 73018
Phone (405) 224-2100

2100 W Iowa Ave
Ste A
Chickasha, OK 73018
Phone (405) 224-2100

Interoperability endpoints

  • Direct secure messaging: mcoppedge@direct.gradymem.org

Organizations & group practices 8

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 9

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": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471305600000",
    "number": "1902887482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 W IOWA AVE",
            "address_2": "SUITE A",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730182736",
            "telephone_number": "405-224-2100",
            "fax_number": "405-779-2855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 W IOWA AVE",
            "address_2": "SUITE A",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730182736",
            "telephone_number": "405-224-2100",
            "fax_number": "405-779-2855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPPEDGE",
        "first_name": "MITCHELL",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2016-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "19462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chickasha, OK

Sources for this page

Verify at the official NPI Registry.