BIG BLUE STAR LLC (NPI# 1396072344) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396072344 |
| Entity Type | Organization |
| Organization Name | BIG BLUE STAR LLC |
| Other Organization Name | WEIGHTWISE |
| Practice Address |
1800 Renaissance Blvd Ste 200 Edmond OK 73013-3023 |
| Practice Telephone | 4043592473 |
| Mailing Telephone | 4043592473 |
| Enumeration Date | 2009-11-12 |
| Last Update Date | 2009-12-17 |
| Authorized Official Name | DR. TOBY DANIEL BROUSSARD (CO OWNER) |
| Authorized Official Telephone | 4059748412 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 174400000X | Specialist | Other Service Providers | ||
| N | 291U00000X | Clinical Medical Laboratory | Laboratories | ||
| Y | 133V00000X | Dietitian, Registered | Dietary & Nutritional Service Providers |
| Other Name | Type Code |
|---|---|
| WeightWise | Doing Business As Name - Organization |
| Street Address |
1800 RENAISSANCE BLVD STE 200 |
| City | EDMOND |
| State | OK |
| Zip Code | 73013-3023 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265090930 | Carley Mclaughlin | Registered Nurse | 1800 Renaissance Blvd Ste 200, Edmond, OK 73013-3023 | 2019-05-29 |
| 1790285849 | Mm Health Aprn-cnp Pllc | Nurse Practitioner | 1800 Renaissance Blvd Ste 200, Edmond, OK 73013-3023 | 2018-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407461866 | Alison Church-pugh | Case Manager/Care Coordinator | 1441 Kelley Pointe Pkwy, Edmond, OK 73013 | 2020-09-12 |
| 1699395343 | Dental Specialists of Edmond | Dentist | 16430 Muirfield Pl, Edmond, OK 73013 | 2020-04-23 |
| 1104477215 | Kammerer Richey LLC | Nurse Practitioner | 902 Nw 139th Street Parway, Edmond, OK 73013 | 2019-09-20 |
| 1811459191 | Peak Movement Centre, Pllc | Clinic/Center | 13816 Santa Fe Crossing Dr, Edmond, OK 73013 | 2019-04-04 |
| 1851858492 | Luma Hilal | Pharmacist | 2228 Nw 15th Terrace, Edmond, OK 73013 | 2019-03-01 |
| 1578031571 | Oklahoma Wellness Group LLC | Internal Medicine | 14101 North Esatern Avenue Suite B, Edmond, OK 73013 | 2018-11-07 |
| 1477034395 | Specialty Care Pediatrics, Inc. | Home Health | 2256 Nw 164th Street, Edmond, OK 73013 | 2018-08-28 |
| 1972083921 | Pooja Bhakta | Physician Assistant | Stanbro Healthcare Group LLC, 2000 E. 15th St., Suite 400-a, Edmond, OK 73013 | 2018-08-20 |
| 1417460577 | Oklahoma Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 15103 N Macarthur Blvd, Oklahoma City, OK 73013 | 2017-11-13 |
| 1356879753 | Shawn Smith Optimal Pt and Performance, Pllc | Physical Therapist | 336 Ne 145th Pl, Edmond, OK 73013 | 2017-05-30 |
| Find all providers in zip 73013 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205467560 | Jennifer Lynn Morrison | Dietitian, Registered | 120 N Bryant Ave Ste A9, Edmond, OK 73034-6300 | 2020-01-27 |
| 1003454067 | Kalyn Lee Khalaf | Dietitian, Registered | 15800 Langley Way, Edmond, OK 73013-0001 | 2019-12-20 |
| 1891343752 | Margaret Tarr Deshazer | Dietitian, Registered | 1 S Broadway Ste 303, Edmond, OK 73034-3706 | 2019-09-03 |
| 1093290207 | Terri Smith | Dietitian, Registered | 3003 Miramonte Circle, Edmond, OK 73003-7300 | 2018-10-03 |
| 1629566120 | Nicholas Daniel Frary | Dietitian, Registered | 2133 E 2nd St Apt 2106, Edmond, OK 73034-1802 | 2018-04-30 |
| 1942705009 | Kayla Hover | Dietitian, Registered | 1800 Dena Dr, Edmond, OK 73003-3760 | 2018-03-29 |
| 1982102570 | Kelsi Haraway | Dietitian, Registered | 832 Gateway Bridge Rd, Edmond, OK 73034-1076 | 2018-01-29 |
| 1891203337 | Lauren Alison Northcutt | Dietitian, Registered | 3500 Nw 164th Ter, Edmond, OK 73013-9471 | 2018-01-18 |
| 1437662160 | Integrated Nutrition Solutions, Pllc | Dietitian, Registered | 6116 Nw 158th St, Edmond, OK 73013-6204 | 2017-11-16 |
| 1083149603 | Brooke Bowlware | Dietitian, Registered | 3325 S Boulevard Ste 169, Edmond, OK 73013-4808 | 2017-04-21 |
| Find all providers in EDMOND | ||||
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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.