NPIMap

Organization Active NPI

David L Shadid DO Inc

  • Psychiatry Physician
  • Tulsa, OK
National Provider Identifier
1992898209
Registry record updated Dec 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
2930 Issued in OK
Legal business name
DAVID L SHADID DO INC
Practice address
4612 S Harvard Ave
Ste a
Tulsa, OK 74135-2908
Phone
(918) 747-5565
Fax
(918) 747-5568
NPI assigned
Oct 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2014

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

Authorized official

Name
Mr. David L Shadid, DONPI 1508934126
Title
President Physician
Phone
(918) 747-5565

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X 2930 OK Primary
Child & Adolescent Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0804X 2930 OK

Addresses

Primary practice location

4612 S Harvard Ave
Ste a
Tulsa, OK 74135-2908

Mailing address

4612 S Harvard Ave
Ste a
Tulsa, OK 74135-2908
Phone (918) 747-5565

Other identifiers 1

IdentifierTypeStateIssuer
200012860AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050122000060 OK Part B Supplier - Clinic/Group Practice 2264482751 Receives reassigned benefits from 1 practitioner
Practice locations: Tulsa, OK

National Provider Directory

National Provider Directory

Locations

2431 E 61st St
Ste 625
Tulsa, OK 74136
Phone (918) 747-5565

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417478400000",
    "number": "1992898209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4612 S HARVARD AVE",
            "address_2": "STE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741352908",
            "telephone_number": "918-747-5565",
            "fax_number": "918-747-5568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4612 S HARVARD AVE",
            "address_2": "STE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741352908",
            "telephone_number": "918-747-5565",
            "fax_number": "918-747-5568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID L SHADID DO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2014-12-02",
        "status": "A",
        "authorized_official_last_name": "SHADID",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT PHYSICIAN",
        "authorized_official_telephone_number": "918-747-5565",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OK",
            "license": "2930",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "OK",
            "license": "2930",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200012860A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.