NPIMap

Organization Active NPI

Ortho Plus, LLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Edmond, OK
National Provider Identifier
1962861625
Registry record updated Aug 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
ORTHO PLUS, LLC
Practice address
941 W I 35 Frontage Rd Ste 164
Edmond, OK 73034-7375
Phone
(405) 285-2994
Fax
(405) 216-3743
NPI assigned
Feb 23, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2024

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

Authorized official

Name
Brent Keith HollimanNPI 1447297296
Title
Auth Official
Phone
(405) 285-2994

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0005X Primary
Medical Specialty Clinic/Center 261QM2500X

Addresses

Primary practice location

941 W I 35 Frontage Rd Ste 164
Edmond, OK 73034-7375

Mailing address

301 Lilac Dr Ste 140
Edmond, OK 73034-7288

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160504002455 OK Part B Supplier - Clinic/Group Practice 1052610524 Receives reassigned benefits from 9 practitioners
Practice locations: Edmond, OK
O20161011001422 OK DME Supplier - Multi-Specialty - PhysicianDME Supplier - Physician - Orthopedic/Orthopedic Surgery 1052610524 Practice locations: Edmond, OK

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D2301907Ortho Plus941 W I-35 Frontage Rd, BLD 164, Edmond, OK 73034Certificate of waiverApr 1, 2028

National Provider Directory

National Provider Directory

Locations

2419 N Commerce St
Ardmore, OK 73401

941 W I 35 Frontage Rd
Ste Ad
Edmond, OK 73034
Phone (405) 285-2994

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1456185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723161600000",
    "number": "1962861625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LILAC DR STE 140",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730347288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "941 W I 35 FRONTAGE RD STE 164",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730347375",
            "telephone_number": "405-285-2994",
            "fax_number": "405-216-3743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHO PLUS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-23",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A",
        "authorized_official_last_name": "HOLLIMAN",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "AUTH OFFICIAL",
        "authorized_official_telephone_number": "405-285-2994"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.