Individual provider Active NPI

Anthony Lee Shelton

  • Internal Medicine Physician
  • Ada, OK
National Provider Identifier
1992365597
Registry record updated Oct 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
34719 Issued in OK
Practice address
1214 Arlington St
Ada, OK 74820-4045
Phone
(580) 436-5111
Fax
(580) 436-1159
NPI assigned
Jun 17, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 34719 OK
Internal Medicine Physician 207R00000X 34719 OK Primary

Addresses

Primary practice location

1214 Arlington St
Ada, OK 74820-4045

Mailing address

527 W 3Rd St
Konawa, OK 74849-1415
Phone (580) 925-3286

Other identifiers 1

IdentifierTypeStateIssuer
34719OtherOKOKLAHOMA BOARD OF MEDICAL LICENSURE AND SUPERVISION

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230808003106 OK Practitioner - Pediatric Medicine 4688094006 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of Oklahoma College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1214 Arlington St
Ada, OK 74820-4045
Phone (580) 436-5111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Central Oklahoma Family Medical Center Inc CurrentSince Jul 1, 2023 Accepting new patients
Central Oklahoma Family Medical Center, Inc CurrentSince Jul 1, 2023 Accepting new patients
Central Oklahoma Family Medical Center, Inc. Current Accepting new patients
Mercy Hospital Ada, Inc Past Accepting new patients

Locations

1221 Arlington St
Ste B
Ada, OK 74820
Phone (580) 332-4700

807 N Monte Vista St
Ada, OK 74820
Phone (580) 279-6413

1214 Arlington St
Ada, OK 74820
Phone (580) 436-2283

304 N Monte Vista St
Ada, OK 74820
Phone (405) 584-4078

527 W 3rd St
Konawa, OK 74849
Phone (580) 925-3286

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1992365597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 W 3RD ST",
            "city": "KONAWA",
            "state": "OK",
            "postal_code": "748491415",
            "telephone_number": "580-925-3286",
            "fax_number": "580-925-2362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1214 ARLINGTON ST",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748204045",
            "telephone_number": "580-436-5111",
            "fax_number": "580-436-1159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELTON",
        "first_name": "ANTHONY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-17",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "34719",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "34719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OKLAHOMA BOARD OF MEDICAL LICENSURE AND SUPERVISION",
            "identifier": "34719",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ada, OK

Sources for this page

Verify at the official NPI Registry.