Active NPI
Autumn Stafford
- Case Manager/Care Coordinator
- Locust Grove, OK
National Provider Identifier
1942662721
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 203 Ewing
Locust Grove, OK 74352-9033 - Phone
- (918) 231-5649
- NPI assigned
- Mar 22, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
203 Ewing
Locust Grove, OK 74352-9033
Mailing address
203 Ewing
Locust Grove, OK 74352-9033
Phone (918) 231-5649
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250714003420 | OK | Order and Referring Only - Mental Health Counselor | 7214442797 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11331 | OK | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458604800000",
"number": "1942662721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 EWING",
"city": "LOCUST GROVE",
"state": "OK",
"postal_code": "743529033",
"telephone_number": "918-231-5649"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 EWING",
"city": "LOCUST GROVE",
"state": "OK",
"postal_code": "743529033",
"telephone_number": "918-231-5649"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAFFORD",
"first_name": "AUTUMN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-22",
"last_updated": "2016-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Locust Grove, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.