Individual provider Active NPI

Amanda J Nichols, DO

  • Family Medicine Physician
  • Tulsa, OK
National Provider Identifier
1912384066
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
6095 Issued in OK
Practice address
7501 Riverside Pkwy
Tulsa, OK 74136-5056
Phone
(918) 710-4200
NPI assigned
Apr 28, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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 6095 OK Primary

Addresses

Primary practice location

7501 Riverside Pkwy
Tulsa, OK 74136-5056

Mailing address

7501 Riverside Pkwy
Tulsa, OK 74136-5056
Phone (918) 710-4200

Other names 1

  • Amanda J Lucashu Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161222000724 OK Practitioner - Family Practice 6103107578 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. John Physicians, Inc.Group PAC ID 2567366495, 262 clinicians

Practice addresses (Care Compare)

1705 E 19TH St
Tulsa, OK 74104-5410

Hospital & facility affiliations

  • Ascension St John Medical Center Hospital, Tulsa, OK, CCN 370114
  • Ascension St John Broken Arrow Hospital, Broken Arrow, OK, CCN 370235
  • Ascension St John Sapulpa Hospital, Sapulpa, OK, CCN 371312

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6095OKMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Care Consultants Region II Inc CurrentSince Nov 2, 2018 Accepting new patients
St. John Physicians, Inc CurrentSince Nov 15, 2016 Accepting new patients
St. John Physicians, Inc. Family Medicine CurrentSince Nov 15, 2016 Accepting new patients
St John Medical Center Inc Past Accepting new patients
St John Urgent Care Clinics Inc PastSince Feb 18, 2024 Accepting new patients

Locations

1801 W 3rd St
Elk City, OK 73644
Phone 5802255403677

501 N 14th St
Perry, OK 73077
Phone (580) 336-3541

1705 E 19th St
Ste 304
Tulsa, OK 74104
Phone (918) 748-7660

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

7501 Riverside Pkwy
Tulsa, OK 74136
Phone (918) 710-4200

Interoperability endpoints

  • Direct secure messaging: amanda.lucashu@direct.stjohnhealthsystem.com
  • Direct secure messaging: amanda.lucashu.1@9147.direct.athenahealth.com

Organizations & group practices 5

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.

Hospital & facility affiliations 4

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": "1430179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1912384066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7501 RIVERSIDE PKWY",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741365056",
            "telephone_number": "918-710-4200",
            "fax_number": "918-403-6352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7501 RIVERSIDE PKWY",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741365056",
            "telephone_number": "918-710-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "AMANDA",
        "middle_name": "J",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-28",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "6095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "LUCASHU",
            "middle_name": "J",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.