| Absentee Shawnee Tribal Health Authority, Inc. | |
|
15951 Little Axe Dr Norman OK 73026-9088 | |
| (405) 447-0300 | |
| (405) 701-7914 |
| Full Name | Absentee Shawnee Tribal Health Authority, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 15951 Little Axe Dr, Norman, Oklahoma |
| Authorized Official Name and Position | Mark Rogers (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4054470300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Absentee Shawnee Tribal Health Authority, Inc. 15951 Little Axe Drive Norman OK 73026-9001 Ph: (405) 447-0300 | Absentee Shawnee Tribal Health Authority, Inc. 15951 Little Axe Dr Norman OK 73026-9088 Ph: (405) 447-0300 |
| NPI Number | 1124152962 |
|---|---|
| Provider Enumeration Date | 03/15/2007 |
| Last Update Date | 03/16/2022 |
| Medicare PECOS PAC ID | 4183895519 |
|---|---|
| Medicare Enrollment ID | O20130227000474 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124152962 | NPI | - | NPPES |
| 100699860P | Medicaid | OK | |
| 100699860N | Medicaid | OK | |
| 100699860A | Medicaid | OK | |
| 100699860O | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (Oklahoma) | Primary |
| Provider Name | Jay Michael Wendorff |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1801889423 PECOS PAC ID: 4082511225 Enrollment ID: I20031216000847 |
| Provider Name | Bruce A Stafford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861479255 PECOS PAC ID: 8820080948 Enrollment ID: I20040403000299 |
| Provider Name | Clarence L Wiley |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1477564797 PECOS PAC ID: 8224001086 Enrollment ID: I20040818001354 |
| Provider Name | Regina M Rhoades |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1558385708 PECOS PAC ID: 9739137241 Enrollment ID: I20050111000388 |
| Provider Name | Christine Ellen Codding |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811968399 PECOS PAC ID: 0244288827 Enrollment ID: I20050119000328 |
| Provider Name | Khalid Ayub Khan |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1306814777 PECOS PAC ID: 6305860834 Enrollment ID: I20060123000858 |
| Provider Name | Basel S Hassoun |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1568579308 PECOS PAC ID: 4981709920 Enrollment ID: I20070419000177 |
| Provider Name | Archana Gautam |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1023158482 PECOS PAC ID: 4082705967 Enrollment ID: I20070807000325 |
| Provider Name | Terri L Steddum |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1093905614 PECOS PAC ID: 3274613047 Enrollment ID: I20080107000143 |
| Provider Name | Jamilet Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588858203 PECOS PAC ID: 5698854404 Enrollment ID: I20080506000152 |
| Provider Name | Matthew T Draelos |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1437221694 PECOS PAC ID: 7315939022 Enrollment ID: I20080701000286 |
| Provider Name | Tariq Mahmood |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1992761589 PECOS PAC ID: 3577623958 Enrollment ID: I20081114000316 |
| Provider Name | Jeremy D King |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1235390907 PECOS PAC ID: 3870653504 Enrollment ID: I20081125000322 |
| Provider Name | Johnny Otis Johnson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538234554 PECOS PAC ID: 0749297299 Enrollment ID: I20090114000040 |
| Provider Name | Toni L Donahoo |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1750461851 PECOS PAC ID: 7517924459 Enrollment ID: I20090120000464 |
| Provider Name | Sridevi Nagumalli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285775759 PECOS PAC ID: 1850445271 Enrollment ID: I20090820000117 |
| Provider Name | Raphael C Francisco |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1124063870 PECOS PAC ID: 9133175185 Enrollment ID: I20091020000715 |
| Provider Name | Marty Lofgren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861464752 PECOS PAC ID: 9537131347 Enrollment ID: I20091028000752 |
| Provider Name | Arthur H Conley |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1720059207 PECOS PAC ID: 1951483353 Enrollment ID: I20100112000107 |
| Provider Name | Brian D Morgan |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1083617054 PECOS PAC ID: 0042393340 Enrollment ID: I20100817000703 |
| Provider Name | Robert White |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164463790 PECOS PAC ID: 9032243621 Enrollment ID: I20100818000538 |
| Provider Name | Kela G Lindsey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427274695 PECOS PAC ID: 7315193463 Enrollment ID: I20120806000864 |
| Provider Name | Eugene G Vitiello |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700049004 PECOS PAC ID: 6608018965 Enrollment ID: I20130815000679 |
| Provider Name | Venkata Rama Gopala Sriharsha Damera |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1861646358 PECOS PAC ID: 5294979076 Enrollment ID: I20130917000522 |
| Provider Name | Limei Yang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003049123 PECOS PAC ID: 2466696778 Enrollment ID: I20130926000096 |
| Provider Name | Preethy T Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881023158 PECOS PAC ID: 1557594389 Enrollment ID: I20140502000094 |
| Provider Name | Kristin Wahpepah |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1447683701 PECOS PAC ID: 8820398506 Enrollment ID: I20151202001022 |
| Provider Name | Kyle V Mcgivern |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1851685747 PECOS PAC ID: 3971894585 Enrollment ID: I20170628000982 |
| Provider Name | Timothy Luke Cramer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275947335 PECOS PAC ID: 2365759172 Enrollment ID: I20170919001564 |
| Provider Name | Dustin Wayne Alexander |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831564269 PECOS PAC ID: 2365747664 Enrollment ID: I20171108001385 |
| Provider Name | Jessica L Kendall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689174989 PECOS PAC ID: 4688935976 Enrollment ID: I20180301001282 |
| Provider Name | Mollie Dilbeck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710498233 PECOS PAC ID: 1557624798 Enrollment ID: I20180420001706 |
| Provider Name | Elizabeth Jane Saladin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326350752 PECOS PAC ID: 7012180649 Enrollment ID: I20180503001393 |
| Provider Name | Jennifer Enoch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588165641 PECOS PAC ID: 5193070308 Enrollment ID: I20180612000748 |
| Provider Name | Monika K Durska-keller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114280807 PECOS PAC ID: 3274811740 Enrollment ID: I20180912002246 |
| Provider Name | Patrick B Reeves |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1003253410 PECOS PAC ID: 3678880325 Enrollment ID: I20181115001443 |
| Provider Name | Susan George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144761073 PECOS PAC ID: 0648516229 Enrollment ID: I20190118001647 |
| Provider Name | Susan Michelle Feeley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457827511 PECOS PAC ID: 3476891631 Enrollment ID: I20190213001495 |
| Provider Name | Gregory Tyler Reading |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1386096832 PECOS PAC ID: 3870831787 Enrollment ID: I20190218002707 |
| Provider Name | Kathryn J Lofgren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013989912 PECOS PAC ID: 3072581404 Enrollment ID: I20190822000679 |
| Provider Name | Kristie Michelle Mcguire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356995476 PECOS PAC ID: 8921431610 Enrollment ID: I20191211001118 |
| Provider Name | Timothy Mark Cathey |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1477601581 PECOS PAC ID: 4981039393 Enrollment ID: I20200113002041 |
| Provider Name | Joseph R Holtzclaw |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1275112278 PECOS PAC ID: 1052712593 Enrollment ID: I20210622002197 |
| Provider Name | Keira A Mccrary |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1508465428 PECOS PAC ID: 2961803358 Enrollment ID: I20210623000378 |
| Provider Name | Lisa Harrington |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1780121806 PECOS PAC ID: 3870994098 Enrollment ID: I20210625001061 |
| Provider Name | Robert Eldon Stone |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1164072161 PECOS PAC ID: 7012313034 Enrollment ID: I20210831000342 |
| Provider Name | Allissa White |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043877756 PECOS PAC ID: 1557696952 Enrollment ID: I20210831003812 |
| Provider Name | Brant T Mccall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023505757 PECOS PAC ID: 0840696738 Enrollment ID: I20210831003845 |
| Provider Name | Tyler Wayne White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740954825 PECOS PAC ID: 6901202845 Enrollment ID: I20210901001886 |
| Provider Name | Tyler Reed Phillips |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164910592 PECOS PAC ID: 0840546511 Enrollment ID: I20210923002343 |
| Provider Name | Travis M Griffiths |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619467610 PECOS PAC ID: 9739437286 Enrollment ID: I20211026002232 |
| Provider Name | Barbra Lynn Caldwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417598574 PECOS PAC ID: 9234520776 Enrollment ID: I20211217000441 |
Empowerme Medical Group, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2803 24th Ave Nw, Norman, OK 73069 Phone: 877-367-9772 | |
Kimberly Davis, Rd/ld, P.c., Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1414 N Porter Ave, Norman, OK 73071 Phone: 405-326-5403 Fax: 405-217-3985 | |
Westport Family Medicine, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2400 Palmer Cir, Norman, OK 73069 Phone: 405-321-6405 Fax: 405-321-6457 | |
Essence Aesthetics, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3321 W Tecumseh Rd Ste 129, Norman, OK 73072 Phone: 405-420-1259 | |
Brookhaven Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2400 Palmer Cir, Norman, OK 73069 Phone: 405-310-2484 Fax: 405-310-2482 | |
Infectious Disease Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 901 N Porter Ave, Norman, OK 73071 Phone: 405-321-8899 Fax: 405-321-4433 | |
Snodgrass Family Chiropractic, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2520 Mcgee Dr Ste 100, Norman, OK 73072 Phone: 405-321-3777 Fax: 405-321-3353 |