Individual provider Active NPI

Mark Adrain Kiefer, MD

  • Colon & Rectal Surgery Physician
  • Tulsa, OK
National Provider Identifier
1992896567
Registry record updated Oct 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
27205 Issued in OK
Practice address
1705 E 19TH St Ste 502
Tulsa, OK 74104-5416
Phone
(918) 748-7800
Fax
(918) 403-6349
NPI assigned
Sep 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 27205 OK
Colon & Rectal Surgery Physician 208C00000X 27205 OK Primary

Addresses

Primary practice location

1705 E 19TH St Ste 502
Tulsa, OK 74104-5416

Mailing address

1705 E 19TH St Ste 502
Tulsa, OK 74104-5416
Phone (918) 748-7800

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
I20090720000582 OK Practitioner - Colorectal Surgery (Proctology) 3274685300 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)
Education
University of Tennessee, HSC, College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. John Physicians, Inc.Group PAC ID 2567366495, 262 clinicians

Practice addresses (Care Compare)

1705 E 19TH St
Tulsa, OK 74104-5410

1923 S Utica Ave
Tulsa, OK 74104-6520
Phone (918) 744-2071

Hospital & facility affiliations

  • Ascension St John Medical Center Hospital, Tulsa, OK, CCN 370114
  • Ascension St John Broken Arrow Hospital, Broken Arrow, OK, CCN 370235
  • St John Owasso Hospital, Owasso, OK, CCN 370227

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as apm

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy73

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc CurrentSince Aug 3, 2009 Accepting new patients
St. John Physicians, Inc. Colon & Rectal Surgery CurrentSince Aug 3, 2009 Accepting new patients
St John Medical Center Inc Past Accepting new patients

Locations

1705 E 19th St
Ste 304
Tulsa, OK 74104
Phone (918) 748-7660

1515 N Harvard Ave
Ste E
Tulsa, OK 74115
Phone (918) 832-6049

1705 E 19th St
Ste 705
Tulsa, OK 74104
Phone (918) 744-7887

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

1705 E 19th St
Ste 502
Tulsa, OK 74104
Phone (918) 743-6675

Organizations & group practices 3

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 4

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": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1992896567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 E 19TH ST STE 502",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045416",
            "telephone_number": "918-748-7800",
            "fax_number": "918-403-6349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 E 19TH ST STE 502",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045416",
            "telephone_number": "918-748-7800",
            "fax_number": "918-403-6349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIEFER",
        "first_name": "MARK",
        "middle_name": "ADRAIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OK",
            "license": "27205",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "OK",
            "license": "27205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.