Elizabeth A Wickersham, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20273 Issued in OK

Practice address

4345 W Memorial Rd
Suite 110
Oklahoma City, OK 73134-1702

Phone

(405) 418-7000

Fax

(405) 418-7099

NPI assigned

Aug 10, 2005

Last updated

Oct 25, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

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

Specialty

Family PracticeAlso: Hospice/Palliative Care

Education

University of Oklahoma College of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Metro Physicians LLCGroup PAC ID 1153794813, 62 clinicians

Metro Healthcare Services LLCGroup PAC ID 7618400557, 33 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SSM Health St Anthony Hospital - Oklahoma City Hospital, Oklahoma City, OK, CCN 370037
• Jackson County Memorial Hospital Authority Hospital, Altus, OK, CCN 370022
• SSM Health St Anthony Hospital - Shawnee Hospital, Shawnee, OK, CCN 370149

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ewickersham29871@ouhealth.direct-ci.net
• Direct secure messaging: ewickersham441160@direct.integrisok.com
• Direct secure messaging: ewickersham452723@direct-ehr-ssmhc.com

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.

• Metro Healthcare Services LLC

  dba Metro Healthcare Services

  • Specialist
  • Oklahoma City, OK
  • NPI 1194558304
  Medicare reassignment Care Compare group NPD
• Metro Physicians LLC

  • Hospitalist Physician
  • Oklahoma City, OK
  • NPI 1588374797
  Medicare reassignment Care Compare group NPD
• Board of Regents of the University of Oklahoma - Ou Physicians

  • Multi-Specialty Clinic/Center
  • Oklahoma City, OK
  • NPI 1801869250
  Medicare reassignment NPD
• Integris Ambulatory Care Corporation

  dba INTEGRIS Medical Group

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1750333936
  Medicare reassignment NPD
• Jackson County Memorial Hospital Authority

  • General Acute Care Hospital
  • Altus, OK
  • NPI 1093763781
  Medicare reassignment NPD
• Jackson County Memorial Hospital Authority

  dba Harmon Memorial Hospital

  • Critical Access Hospital
  • Hollis, OK
  • NPI 1295735991
  Medicare reassignment NPD
• Ou Health Partners, Inc

  dba Ou Health Partners

  • Multi-Specialty Clinic/Center
  • Oklahoma City, OK
  • NPI 1528642642
  Medicare reassignment NPD
• St Anthony Shawnee Hospital Inc

  dba St Anthony Shawnee Hospital

  • Surgery Physician
  • Shawnee, OK
  • NPI 1619260411

  Family Medicine

  Medicare reassignment NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  OK

  Medicare reassignment NPD
• Mercy Clinic Oklahoma Communities

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1386874550
  Medicare reassignment
• Board of Regents of the University of Oklahoma - Ou Physicians

  • Multi-Specialty Clinic/Center
  • Edmond, OK
  • NPI 1124646971
  NPD
• Ou Health Partners, Inc

  dba OUHP Orthotics & Prosthetic

  • Prosthetic/Orthotic Supplier
  • Oklahoma City, OK
  • NPI 1447834460
  NPD

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

• Jackson County Memorial Hospital Authority

  • General Acute Care Hospital
  • Altus, OK
  • NPI 1093763781
  Care Compare affiliation
• SSM Health Care of Oklahoma Inc

  dba SSM Health Pharmacy

  • Community/Retail Pharmacy
  • Oklahoma City, OK
  • NPI 1649602293

  Hospital

  Care Compare affiliation
• SSM Health Care of Oklahoma, Inc.

  dba SSM Health St. Anthony Hospital - Oklahoma City

  • General Acute Care Hospital
  • Oklahoma City, OK
  • NPI 1366545311
  Care Compare affiliation
• St Anthony Shawnee Hospital Inc

  dba St Anthony Shawnee Hospital

  • General Acute Care Hospital
  • Shawnee, OK
  • NPI 1134123193
  Care Compare affiliation

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1992706048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4345 W MEMORIAL RD",
            "address_2": "SUITE 110",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341702",
            "telephone_number": "405-418-7000",
            "fax_number": "405-418-7099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4345 W MEMORIAL RD",
            "address_2": "SUITE 110",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341702",
            "telephone_number": "405-418-7000",
            "fax_number": "405-418-7099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13920 Quailbrook Dr",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731341718",
            "country_code": "US",
            "telephone_number": "405-848-8884",
            "fax_number": "405-713-4656",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WICKERSHAM",
        "first_name": "ELIZABETH",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-10",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "20273",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "OK",
            "license": "20273",
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "OK",
            "license": "20273",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200036870A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Whole Human Life PLLC
• Wholestic Counseling Services. P.L.L.C.
• Kwame Wiafe
• Shannon E Wickenhauser, BHRS
• Amy Brooke Wicker, FNP
• Dayton Wickham
• Ryan Wicks, MD
• Taylor Wicks
• Teresa C Wicks
• Wickshire Oklahoma City Opco LLC (Wickshire Oklahoma City)

• Family Medicine Physician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; 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.
• 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.