Individual provider Active NPI

Annie Venugopal, MD

  • Physical Medicine & Rehabilitation Physician
  • Tulsa, OK
National Provider Identifier
1992788368
Registry record updated Feb 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
13326 Issued in OK
Practice address
1705 E 19TH Street
Suite 501
Tulsa, OK 74104-5416
Phone
(918) 744-8110
Fax
(918) 744-8111
NPI assigned
Nov 21, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 8, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 13326 OK Primary

Addresses

Primary practice location

1705 E 19TH Street
Suite 501
Tulsa, OK 74104-5416

Mailing address

1705 E 19TH Street
Suite 501
Tulsa, OK 74104-5416
Phone (918) 744-8110

Other identifiers 1

IdentifierTypeStateIssuer
100009780AMedicaidOK

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
I20100329000976 OK Practitioner - Physical Medicine and Rehabilitation 6204962277 Practice locations: Tulsa, OK

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6966 S Utica Ave
Tulsa, OK 74136-3903
Phone (918) 744-8110

Hospital & facility affiliations

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: annie.venugopal@direct.stjohnhealthsystem.com

Hospital & facility affiliations 7

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": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265587200000",
    "number": "1992788368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 E 19TH STREET",
            "address_2": "SUITE 501",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045416",
            "telephone_number": "918-744-8110",
            "fax_number": "918-744-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 E 19TH STREET",
            "address_2": "SUITE 501",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045416",
            "telephone_number": "918-744-8110",
            "fax_number": "918-744-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENUGOPAL",
        "first_name": "ANNIE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-21",
        "last_updated": "2010-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "OK",
            "license": "13326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100009780A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.