Active NPI
Eric M Dedeke, M.D.
- Family Medicine Physician
- Oklahoma City, OK
National Provider Identifier
1922046960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 24455
- Practice address
- 10914 Hefner Pointe Dr Ste 202
Oklahoma City, OK 73120-5071 - Phone
- (405) 815-6840
- Fax
- (405) 815-6839
- NPI assigned
- Jun 3, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 24455 | OK | Primary |
| Clinical Informatics Physician | 2083C0008X | 24455 | OK |
Addresses
Primary practice location
10914 Hefner Pointe Dr Ste 202
Oklahoma City, OK 73120-5071
Mailing address
5300 N Independence Ave
Suite 280
Oklahoma City, OK 73112-5556
Phone (405) 815-6840
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200065740A | Medicaid | OK |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Oklahoma College of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3400 NW Expressway
Suite 500
Oklahoma City, OK 73112-4492
Phone (405) 945-4589
Hospital & facility affiliations
- Elara Caring XX
- Integris Baptist Medical Center, Inc
- O U Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24455 | OK | MD | Clinical Informatics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integris Ambulatory Care C Orporation | Family Medicine | Past | Accepting new patients |
| Summit Medical Center | Past | Accepting new patients |
Interoperability endpoints
- ededeke9381@direct.integrisok.com
Organizations & group practices 3
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.
-
- Family Medicine Physician
- Oklahoma City, OK
- NPI 1750333936
-
- Family Medicine Physician
- Oklahoma City, OK
- NPI 1326076027
-
- General Acute Care Hospital
- Edmond, OK
- NPI 1356574560
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Oklahoma City, OK
- NPI 1447380670
-
- Psychiatric Hospital Unit
- Oklahoma City, OK
- NPI 1598837221
-
- Psychiatric Hospital Unit
- Spencer, OK
- NPI 1659443372
-
- General Acute Care Hospital
- Oklahoma City, OK
- NPI 1831103654
-
- Psychiatric Hospital Unit
- Spencer, OK
- NPI 1881760759
-
- General Acute Care Hospital
- Oklahoma City, OK
- NPI 1649794157
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149292800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605484800000",
"number": "1922046960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5300 N INDEPENDENCE AVE",
"address_2": "SUITE 280",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731125556",
"telephone_number": "405-815-6840",
"fax_number": "405-815-6839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10914 HEFNER POINTE DR STE 202",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731205071",
"telephone_number": "405-815-6840",
"fax_number": "405-815-6839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDEKE",
"first_name": "ERIC",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-03",
"last_updated": "2020-11-16",
"certification_date": "2020-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "24455",
"primary": true
},
{
"code": "2083C0008X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Clinical Informatics",
"state": "OK",
"license": "24455",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200065740A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; 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.