OSUMC PROFESSIONAL SERVICES LLC (NPI# 1154845501) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154845501 |
| Entity Type | Organization |
| Organization Name | OSUMC PROFESSIONAL SERVICES LLC |
| Other Organization Name | OSU MEDICAL GROUP SAND SPRINGS PRIMARY CARE |
| Practice Address |
514 Plaza Ct Sand Springs OK 74063-7915 |
| Practice Telephone | (918) 215-5100 |
| Practice Fax Number | 9182155105 |
| Mailing Telephone | 9182155100 |
| Mailing Fax Number | 9182155105 |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2017-07-27 |
| Authorized Official Name | SAMANTHA OVERFIELD (CREDENTIALING ADMINISTRATOR) |
| Authorized Official Telephone | 9185615714 |
| Is Organization Subpart | Y |
| Parent Organization Name | OSUMC PROFESSIONAL SERVICES LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
5451 | OK | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | MEDICARE | OKA101159 | 01 |
| OK | 200308130A | 05 | |
| OK | RR MEDICARE PTAN | DR7481 | 01 |
| Other Name | Type Code |
|---|---|
| OSU Medical Group Sand Springs Primary Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730793696 | Osumc Professional Services LLC | Family Medicine | 112 W 5th Street, Okmulgee, OK 74447-0000 | 2020-09-08 |
| 1922325992 | Osumc Professional Services LLC | Internal Medicine | 744 W 9th St, Tulsa, OK 74127-9020 | 2010-04-29 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oklahoma Business Registrations | OSUMC PROFESSIONAL SERVICES LLC | 744 W. 9th Street, Tulsa, OK 74127-9020 |
| Street Address |
514 PLAZA CT |
| City | SAND SPRINGS |
| State | OK |
| Zip Code | 74063-7915 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669884987 | James Nelson Cornwell | Family Medicine | 514 Plaza Ct, Sand Springs, OK 74063 | 2014-05-21 |
| 1154965556 | Osu Center for Health Sciences | Clinic/Center | 514 Plaza Ct, Sand Springs, OK 74063-7915 | 2019-10-30 |
| 1124411749 | Mallory Dayle White | Nurse Practitioner | 514 Plaza Ct, Sand Springs, OK 74063-7915 | 2015-03-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760083166 | Kyle A Russell | Pharmacist | 220 S St, Hwy Ok- 97, Sand Springs, OK 74063 | 2020-11-03 |
| 1609474758 | Sand Springs Dentistry and Braces | Clinic/Center | 152 W. Alexander Blvd, Ste E, Sand Springs, OK 74063 | 2020-10-12 |
| 1689189987 | Constance Rebecca Dimond | Pharmacist | 251 South Hwy 97, Sand Springs, OK 74063 | 2017-12-08 |
| 1104272608 | Rebecca Schulz | Midwife | 20361 W 51st Street, Sand Springs, OK 74063 | 2016-05-13 |
| 1801295266 | Tifhanie Edison | Social Worker | 118 Imperial Blvd, Sandsprings, OK 74063 | 2014-08-21 |
| 1518372770 | Spring Innovations Ok PC | Dentist | 530 Plaza Court, Sand Springs, OK 74063 | 2014-06-26 |
| 1366874190 | Tim B. Williamson | Acupuncturist | 608 W 41st St, Sand Springs, OK 74063 | 2013-08-03 |
| 1205153483 | Excel Therapy Specialists, LLC | Physical Therapist | 422 Plaza Ct., Ste. A, Sand Springs, OK 74063 | 2010-04-27 |
| 1548592512 | Shannon Kathleen Marie Christmas | Counselor | 401 E Broadway Ct, Suite E, Sand Springs, OK 74063 | 2010-02-02 |
| 1073841144 | Stephanie Sims | Specialist/Technologist, Other | 3812 S Bermuda Ave, Sand Springs, OK 74063 | 2009-11-30 |
| Find all providers in zip 74063 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679936348 | Bryce Rudek | Family Medicine | 591 Pendleton St, Tahlequah, OK 74464-2271 | 2016-03-31 |
| 1619355849 | Leslie Beaty | Family Medicine | 4227 Macys Pl, Moore, OK 73160-2879 | 2015-05-07 |
| 1396044764 | Michelle Rockwell | Family Medicine | 2950 S Elm Pl Ste 120, Broken Arrow, OK 74012-7816 | 2011-03-23 |
| 1902078298 | Steve Eric Randall | Family Medicine | 5104 S Sooner Rd, Oklahoma City, OK 73135-5440 | 2008-03-27 |
| 1407035447 | Steven D. King, D.o., P.c | Family Medicine | 501 E 15th St Ste 400b, Edmond, OK 73013-5040 | 2007-10-26 |
| 1356314603 | Ryan A Pitts | Family Medicine | 301 N Broadway St Ste 301, Poteau, OK 74953-3355 | 2006-02-08 |
| 1518967561 | Steven R Hardage | Family Medicine | 1110 W Will Rogers Blvd, Claremore, OK 74017 | 2005-07-29 |
| 1205836244 | T Jeffrey Emel | Family Medicine | 6475 S Yale Ave Ste 301, Tulsa, OK 74136 | 2005-07-29 |
| 1699311308 | Acellerated Interventional Orthopedics | Family Medicine | 1002 Ne Highway 66 Ste 3, Sayre, OK 73662-9312 | 2019-11-18 |
| 1104219385 | Avenstar Pain Specialists, Pllc | Family Medicine | 5104 S Sooner Rd, Oklahoma City, OK 73135-5440 | 2015-03-11 |
| Find all providers with the same taxonomy | ||||
| City | SAND SPRINGS |
| Zip Code | 74063 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.