NPIMap

Individual provider Active NPI

Tyler Joshua Mitchum, DO

  • Family Medicine Physician
  • Yukon, OK
National Provider Identifier
1992375752
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
7765 Issued in OK
Practice address
1205 Health Center Pkwy Ste 100
Yukon, OK 73099-6396
Phone
(405) 717-5400
Fax
(405) 717-5467
NPI assigned
Jun 24, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 7765 OK Primary

Addresses

Primary practice location

1205 Health Center Pkwy Ste 100
Yukon, OK 73099-6396

Mailing address

3001 Quail Springs Pkwy FL 5
Oklahoma City, OK 73134-2640
Phone (405) 717-5400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240612001956 OK Practitioner - Family Practice 7911449400 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oklahoma State University College of Osteopathic Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integris Ambulatory Care CorporationGroup PAC ID 2365408465, 687 clinicians

Practice addresses (Care Compare)

1205 Health Ctr Pkwy
Suite 100
Yukon, OK 73099-6396
Phone (405) 717-5400

Hospital & facility affiliations

  • Elara Caring XX Home health agency, Oklahoma City, OK, CCN 377648
  • Integris Home Care Oklahoma City Home health agency, Oklahoma City, OK, CCN 377051
  • Integris Canadian Valley Hospital Hospital, Yukon, OK, CCN 370211
  • Integris Baptist Medical Center, Inc Hospital, Oklahoma City, OK, CCN 370028
  • Integris Southwest Medical Center Hospital, Oklahoma City, OK, CCN 370106

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Integris Ambulatory Care Corporation Family Medicine CurrentSince Jul 22, 2024 Accepting new patients
Integris Ambulatory Care C Orporation Family Medicine Past Accepting new patients
Summit Medical Center Past Accepting new patients
Integris Canadian Valley Hospital Past Accepting new patients

Locations

3001 Quail Springs Pkwy
Fl 5
Oklahoma City, OK 73134

3500 NW 56th St
Ste 100
Oklahoma City, OK 73112
Phone (405) 951-2855

3400 NW Expressway
Ste 500
Oklahoma City, OK 73112
Phone (405) 945-4589

1205 Health Center Pkwy
Ste 100
Yukon, OK 73099
Phone (405) 350-1882

Interoperability endpoints

  • Direct secure messaging: tmitchum215029@direct.integrisok.com

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 10

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": "1624492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1992375752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 QUAIL SPRINGS PKWY FL 5",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731342640",
            "telephone_number": "405-717-5400",
            "fax_number": "405-717-5467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 HEALTH CENTER PKWY STE 100",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730996396",
            "telephone_number": "405-717-5400",
            "fax_number": "405-717-5467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHUM",
        "first_name": "TYLER",
        "middle_name": "JOSHUA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-24",
        "last_updated": "2024-08-05",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "7765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yukon, OK

Sources for this page

Verify at the official NPI Registry.