Organization Active NPI

Family Care of Tulsa, Inc

  • Family Medicine Physician
  • Tulsa, OK
National Provider Identifier
1902945439
Registry record updated Jul 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01897 Issued in OK
Legal business name
FAMILY CARE OF TULSA, INC
Practice address
4720 S Harvard Ave
Ste 102
Tulsa, OK 74135-3048
Phone
(918) 744-0194
Fax
(918) 744-4085
NPI assigned
Feb 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2010

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

Authorized official

Name
Don R Roller, MDNPI 1871577940
Title
Owner
Phone
(918) 744-0194

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 01897 OK Primary

Addresses

Primary practice location

4720 S Harvard Ave
Ste 102
Tulsa, OK 74135-3048

Mailing address

4720 S Harvard Ave
Ste 102
Tulsa, OK 74135-3048
Phone (918) 744-0194

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050811001153 OK Part B Supplier - Clinic/Group Practice 9133158884 Receives reassigned benefits from 1 practitioner
Practice locations: Tulsa, OK

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D0473983Family Care of Tulsa, Inc4720 South Harvard, Suite 102, Tulsa, OK 74135Certificate of waiverApr 2, 2027

National Provider Directory

National Provider Directory

Locations

4720 S Harvard Ave
Ste 102
Tulsa, OK 74135
Phone (918) 744-0194

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278633600000",
    "number": "1902945439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4720 S HARVARD AVE",
            "address_2": "STE 102",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741353048",
            "telephone_number": "918-744-0194",
            "fax_number": "918-744-4085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4720 S HARVARD AVE",
            "address_2": "STE 102",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741353048",
            "telephone_number": "918-744-0194",
            "fax_number": "918-744-4085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE OF TULSA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2010-07-09",
        "status": "A",
        "authorized_official_last_name": "ROLLER",
        "authorized_official_first_name": "DON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-744-0194",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "01897",
            "primary": true
        }
    ],
    "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 Jul 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.