Samuel Jay Pangburn, DO

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

3593 Issued in OK

Practice address

10505 E 91St St Ste 203
Tulsa, OK 74133

Phone

(918) 307-3120

Fax

(918) 307-3121

NPI assigned

Dec 28, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

General Surgery

Education

Oklahoma State University College of Osteopathic Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Warren Clinic IncGroup PAC ID 8820900293, 787 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Francis Hospital South, LLC Hospital, Tulsa, OK, CCN 370218
• Saint Francis Hospital, Inc Hospital, Tulsa, OK, CCN 370091

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: spangburn104222@direct.saintfrancis.com

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.

• Warren Clinic Inc

  • General Practice Physician
  • Tulsa, OK
  • NPI 1174582282
  Medicare reassignment Care Compare group NPD
• Samuel J. Pangburn, D.O., PA

  • Surgery Physician
  • Orange, TX
  • NPI 1265620371
  NPD (past) Authorized official
• Fairfax Healthcare Properties,L.L.C.

  • Medicare Defined Swing Bed Hospital Unit
  • Fairfax, OK
  • NPI 1922143098
  NPD (past)
• Mayes County Hma, LLC

  • General Acute Care Hospital
  • Pryor, OK
  • NPI 1588686679
  NPD (past)
• Saint Francis Hospital South LLC

  • General Acute Care Hospital
  • Tulsa, OK
  • NPI 1376561944
  NPD (past)
• Surgical Practices of South Texas, PLLC

  • Neurological Surgery Physician
  • San Antonio, TX
  • NPI 1821021437
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Saint Francis Hospital South LLC

  • General Acute Care Hospital
  • Tulsa, OK
  • NPI 1376561944
  Care Compare affiliation
• Saint Francis Hospital, Inc.

  • Rehabilitation Hospital Unit
  • Tulsa, OK
  • NPI 1003039488
  Care Compare affiliation
• Saint Francis Hospital, Inc.

  • General Acute Care Hospital
  • Tulsa, OK
  • NPI 1144228487
  Care Compare affiliation

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1922085216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 S YALE AVE STE 14000",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363347",
            "telephone_number": "888-247-0125",
            "fax_number": "918-502-8210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10505 E 91ST ST STE 203",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74133",
            "telephone_number": "918-307-3120",
            "fax_number": "918-307-3121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8042 Wurzbach Rd",
            "address_2": "Ste 310",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782293818",
            "country_code": "US",
            "telephone_number": "210-614-5113",
            "fax_number": "210-614-7938",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PANGBURN",
        "first_name": "SAMUEL",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-28",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OK",
            "license": "3593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100096880A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171802501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chris A Pancratz, D.C.
• Vijay Mahadev Pandav, M.D.
• Robin Natalie Pander
• Rosa Pando
• Hillary Pane, MD
• Molly Pangestu
• Nicole Pankey, RN
• Barrett Pannell, OD
• Shavonda Pannell, D.C.
• Tiffany Rae Pannell, PTA

• Surgery Physician in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Surgery Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; 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.

Verify at the official NPI Registry.