TULSA PEDIATRIC AND ADOLESCENT MEDICINE, PC (NPI# 1215975883) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215975883 |
| Entity Type | Organization |
| Organization Name | TULSA PEDIATRIC AND ADOLESCENT MEDICINE, PC |
| Practice Address |
1919 S Wheeling Ave Suite 304 Tulsa OK 74104-5638 |
| Practice Telephone | 9187487620 |
| Practice Fax Number | 9187487647 |
| Mailing Telephone | 9187487620 |
| Mailing Fax Number | 9187487647 |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | JOEL K GIST (PRESIDENT) |
| Authorized Official Telephone | 9187487620 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Street Address |
1919 S WHEELING AVE SUITE 304 |
| City | TULSA |
| State | OK |
| Zip Code | 74104-5638 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942293097 | Michael S Charles | Surgery | 1919 S Wheeling Ave, Ste 606, Tulsa, OK 74104-5635 | 2005-08-24 |
| 1710540737 | Lacie Danielle Whinery | Student in an Organized Health Care Education/Training Program | 1919 S Wheeling Ave, Tulsa, OK 74104-5638 | 2019-04-16 |
| 1699134890 | Allyson Michelle Campbell | Physician Assistant | 1919 S Wheeling Ave, Suite 404, Tulsa, OK 74104-5638 | 2016-02-16 |
| 1205200789 | Aerial Chanel Anthony | Physician Assistant | 1919 S Wheeling Ave, Suite 200, Tulsa, OK 74104-5638 | 2015-11-19 |
| 1285018713 | Ob Gyn Specialists of Tulsa Pllc | Obstetrics & Gynecology | 1919 S Wheeling Ave, Ste. 700, Tulsa, OK 74104-5638 | 2015-07-14 |
| 1083025159 | Osu Center for Health Sciences | Clinic/Center | 1919 S Wheeling Ave, Suite 302, Tulsa, OK 74104-5638 | 2014-05-12 |
| 1548688757 | Robert Wittrock | Pediatrics | 1919 S Wheeling Ave, Ste 304, Tulsa, OK 74104-5632 | 2014-04-03 |
| 1235477613 | Alexandros Mallios | Surgery | 1919 S Wheeling Ave, Suite 600, Tulsa, OK 74104-5638 | 2013-01-20 |
| 1841537859 | Jenny Marie Birks | Physician Assistant | 1919 S Wheeling Ave, Suite 402, Tulsa, OK 74104-5638 | 2013-01-10 |
| 1578836201 | Gajal Kumar | Surgery | 1919 S Wheeling Ave, Ste 606, Tulsa, OK 74104-5638 | 2012-02-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982253811 | Ultimate Health and Pain Management | Pain Medicine | 1844 East 15th Street, Tulsa, OK 74104 | 2019-09-04 |
| 1225691223 | David Murray | Student in an Organized Health Care Education/Training Program | 2100 S Wheeling Ave, Tulsa, OK 74104 | 2019-04-16 |
| 1083115828 | Susan Fortner | Counselor | 1328 S. Delaware Pl, Tulsa, OK 74104 | 2018-02-27 |
| 1033636915 | Mark Brizendine | Dietitian, Registered | Hillcrest Medical Center 1120 S. Utica Ave, Tulsa, OK 74104 | 2017-08-23 |
| 1295259067 | Demi Reyd Cook | Nurse Practitioner | 1717 A South Utica, Tulsa, OK 74104 | 2017-08-02 |
| 1851827059 | Oklahoma Cvs Pharmacy | Durable Medical Equipment & Medical Supplies | 1701 E 15th Street, Tulsa, OK 74104 | 2017-05-08 |
| 1801334982 | Jamie Lynne Miller | Internal Medicine | 2000 S. Wheeling Avenue Ste 510, Tulsa, OK 74104 | 2017-02-08 |
| 1578913430 | Donna Durant-macon | Registered Nurse | 315 South Utica, Tulsa, OK 74104 | 2016-06-21 |
| 1669833851 | Mbc Dental | Dentist | 401 S. Utica Ave, #a, Tulsa, OK 74104 | 2016-03-15 |
| 1518332170 | Neuro Dynamics LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 22 S Lewis, Tulsa, OK 74104 | 2015-12-08 |
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| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679067664 | Laurie Ann Alfrey | Pediatrics | 1025 E 18th St, Tulsa, OK 74120-7406 | 2018-06-21 |
| 1114468436 | Vanessa Boshuizen | Pediatrics | 12020 E 31st St, Tulsa, OK 74146-2001 | 2017-03-20 |
| 1407390115 | Empower Pediatrics | Pediatrics | 9659 Riverside Pkwy, Tulsa, OK 74137-7398 | 2016-12-14 |
| 1346660834 | Amber Lee Shipman | Pediatrics | 3516 E 31st Street South, Suite B, Tulsa, OK 74135 | 2014-04-23 |
| 1811239569 | Sara Mcdonald | Pediatrics | 1919 S Wheeling Ave Ste 304, Tulsa, OK 74104-5632 | 2013-03-20 |
| 1265782338 | Milestones Pediatric Urgent Care | Pediatrics | 3863 South 103rd E Avenue, Tulsa, OK 74146 | 2012-09-14 |
| 1588982219 | Mary Emlyn Garber Baird | Pediatrics | 4444 East 41st Street, Ou Pediatrics, Tulsa, OK 74135-2512 | 2010-05-05 |
| 1982859963 | Board of Regents of The University of Oklahoma Ou Physicians Tulsa | Pediatrics | 4502 E 41st Street, 2g08, Ou Physicians Tulsa Community Health, Tulsa, OK 74135-2529 | 2008-11-18 |
| 1184872004 | Board of Regents of The University of Oklahoma Ou Physicians Tulsa | Pediatrics | 619 S. Quincy Ave., Ouptch-laura Dester Shelter, Tulsa, OK 74120 | 2008-09-04 |
| 1437307550 | Board of Regents of The University of Oklahoma Ou Physicians Tulsa | Pediatrics | 8811 E. 31st Street South, Ouptch-skelly, Tulsa, OK 74145 | 2008-09-03 |
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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.