Active NPI
George Mumford Pendell III, M.D.
- Family Medicine Physician
- Tulsa, OK
National Provider Identifier
1952361834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 18257
- Practice address
- 9001 S 101St East Ave
Ste 270
Tulsa, OK 74133-5708 - Phone
- (918) 392-7000
- Fax
- (918) 392-7013
- NPI assigned
- Mar 24, 2006
- Last updated
- May 6, 2014
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 18257 | OK | Primary |
Addresses
Primary practice location
9001 S 101St East Ave
Ste 270
Tulsa, OK 74133-5708
Mailing address
9001 S 101St East Ave
Ste 270
Tulsa, OK 74133-5708
Phone (918) 392-7000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100131790A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 21, 2018 through Feb 21, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Broken Arrow Medical Group LLC | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399334400000",
"number": "1952361834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9001 S 101ST EAST AVE",
"address_2": "STE 270",
"city": "TULSA",
"state": "OK",
"postal_code": "741335708",
"telephone_number": "918-392-7000",
"fax_number": "918-392-7013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9001 S 101ST EAST AVE",
"address_2": "STE 270",
"city": "TULSA",
"state": "OK",
"postal_code": "741335708",
"telephone_number": "918-392-7000",
"fax_number": "918-392-7013"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDELL",
"first_name": "GEORGE",
"middle_name": "MUMFORD",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2014-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "18257",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100131790A",
"state": "OK"
}
],
"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 May 6, 2014; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.