Absentee Shawnee Tribal Health System - Shawnee Clinic - Medicare Primary Care in Shawnee, OK

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Absentee Shawnee Tribal Health System - Shawnee Clinic is a medicare enrolled primary clinic (Clinic/center - Multi-specialty) in Shawnee, Oklahoma. The current practice location for Absentee Shawnee Tribal Health System - Shawnee Clinic is 2029 S Gordon Cooper Drive, Shawnee, Oklahoma. For appointments, you can reach them via phone at (405) 878-5850. The mailing address for Absentee Shawnee Tribal Health System - Shawnee Clinic is 15951 Little Axe Drive, Norman, Oklahoma and phone number is (405) 447-0300.

Absentee Shawnee Tribal Health System - Shawnee Clinic is licensed to practice in Oklahoma (license number ). The clinic also participates in the medicare program and its NPI number is 1942253521. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (405) 878-5850.

Contact Information

Absentee Shawnee Tribal Health System - Shawnee Clinic
2029 S Gordon Cooper Drive
Shawnee
OK 74801
(405) 878-5850
(405) 214-4227

Map and Direction


Primary Care Clinic Profile

Full NameAbsentee Shawnee Tribal Health System - Shawnee Clinic
SpecialityClinic/Center
Location2029 S Gordon Cooper Drive, Shawnee, Oklahoma
Authorized Official Name and PositionMark Rogers (EXECUTIVE DIRECTOR)
Authorized Official Contact4054470300
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Absentee Shawnee Tribal Health System - Shawnee Clinic
15951 Little Axe Drive
Norman
OK 73026-9001

Ph: (405) 447-0300		Absentee Shawnee Tribal Health System - Shawnee Clinic
2029 S Gordon Cooper Drive
Shawnee
OK 74801

Ph: (405) 878-5850

NPI Details:

NPI Number1942253521
Provider Enumeration Date05/18/2006
Last Update Date03/16/2022

Medicare PECOS Information:

Medicare PECOS PAC ID9335053479
Medicare Enrollment IDO20031113000654

Medical Identifiers

Medical identifiers for Absentee Shawnee Tribal Health System - Shawnee Clinic such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1942253521NPI-NPPES
100699860KMedicaidOK
100699860JMedicaidOK

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
261QM1300XClinic/center - Multi-specialty (Oklahoma)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Absentee Shawnee Tribal Health System - Shawnee Clinic acts as a billing entity for following providers:
Provider NameJay Michael Wendorff
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1801889423
PECOS PAC ID: 4082511225
Enrollment ID: I20031216000847
Provider NameBruce A Stafford
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1861479255
PECOS PAC ID: 8820080948
Enrollment ID: I20040403000299
Provider NameChristine Ellen Codding
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1811968399
PECOS PAC ID: 0244288827
Enrollment ID: I20050119000328
Provider NameKhalid Ayub Khan
Provider TypePractitioner - Pain Management
Provider IdentifiersNPI Number: 1306814777
PECOS PAC ID: 6305860834
Enrollment ID: I20060123000858
Provider NameBasel S Hassoun
Provider TypePractitioner - Urology
Provider IdentifiersNPI Number: 1568579308
PECOS PAC ID: 4981709920
Enrollment ID: I20070419000177
Provider NameArchana Gautam
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1023158482
PECOS PAC ID: 4082705967
Enrollment ID: I20070807000325
Provider NameJamilet Gonzalez
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1588858203
PECOS PAC ID: 5698854404
Enrollment ID: I20080506000152
Provider NameTariq Mahmood
Provider TypePractitioner - Hematology/oncology
Provider IdentifiersNPI Number: 1992761589
PECOS PAC ID: 3577623958
Enrollment ID: I20081114000316
Provider NameJohnny Otis Johnson
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1538234554
PECOS PAC ID: 0749297299
Enrollment ID: I20090114000040
Provider NameSridevi Nagumalli
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1285775759
PECOS PAC ID: 1850445271
Enrollment ID: I20090820000117
Provider NameRaphael C Francisco
Provider TypePractitioner - Endocrinology
Provider IdentifiersNPI Number: 1124063870
PECOS PAC ID: 9133175185
Enrollment ID: I20091020000715
Provider NameMarty Lofgren
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1861464752
PECOS PAC ID: 9537131347
Enrollment ID: I20091028000752
Provider NameRobert White
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1164463790
PECOS PAC ID: 9032243621
Enrollment ID: I20100818000538
Provider NameKela G Lindsey
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1427274695
PECOS PAC ID: 7315193463
Enrollment ID: I20120806000864
Provider NameEugene G Vitiello
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1700049004
PECOS PAC ID: 6608018965
Enrollment ID: I20130815000679
Provider NamePreethy T Thomas
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1881023158
PECOS PAC ID: 1557594389
Enrollment ID: I20140502000094
Provider NameKristin Wahpepah
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1447683701
PECOS PAC ID: 8820398506
Enrollment ID: I20151202001022
Provider NameDustin Wayne Alexander
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1831564269
PECOS PAC ID: 2365747664
Enrollment ID: I20171108001385
Provider NameJessica L Kendall
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1689174989
PECOS PAC ID: 4688935976
Enrollment ID: I20180301001282
Provider NameMollie Dilbeck
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1710498233
PECOS PAC ID: 1557624798
Enrollment ID: I20180420001706
Provider NameElizabeth Jane Saladin
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1326350752
PECOS PAC ID: 7012180649
Enrollment ID: I20180503001393
Provider NameJennifer Enoch
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1588165641
PECOS PAC ID: 5193070308
Enrollment ID: I20180612000748
Provider NameMonika K Durska-keller
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1114280807
PECOS PAC ID: 3274811740
Enrollment ID: I20180912002246
Provider NameSusan George
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1144761073
PECOS PAC ID: 0648516229
Enrollment ID: I20190118001647
Provider NameSusan Michelle Feeley
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1457827511
PECOS PAC ID: 3476891631
Enrollment ID: I20190213001495
Provider NameGregory Tyler Reading
Provider TypePractitioner - Chiropractic
Provider IdentifiersNPI Number: 1386096832
PECOS PAC ID: 3870831787
Enrollment ID: I20190218002707
Provider NameKathryn J Lofgren
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1013989912
PECOS PAC ID: 3072581404
Enrollment ID: I20190822000679
Provider NameKristie Michelle Mcguire
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1356995476
PECOS PAC ID: 8921431610
Enrollment ID: I20191211001118
Provider NameTimothy Mark Cathey
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1477601581
PECOS PAC ID: 4981039393
Enrollment ID: I20200113002041
Provider NameJoseph R Holtzclaw
Provider TypePractitioner - Registered Dietitian Or Nutrition Professional
Provider IdentifiersNPI Number: 1275112278
PECOS PAC ID: 1052712593
Enrollment ID: I20210622002197
Provider NameKeira A Mccrary
Provider TypePractitioner - Registered Dietitian Or Nutrition Professional
Provider IdentifiersNPI Number: 1508465428
PECOS PAC ID: 2961803358
Enrollment ID: I20210623000378
Provider NameLisa Harrington
Provider TypePractitioner - Registered Dietitian Or Nutrition Professional
Provider IdentifiersNPI Number: 1780121806
PECOS PAC ID: 3870994098
Enrollment ID: I20210625001061
Provider NameRobert Eldon Stone
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1164072161
PECOS PAC ID: 7012313034
Enrollment ID: I20210831000342
Provider NameAllissa White
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1043877756
PECOS PAC ID: 1557696952
Enrollment ID: I20210831003812
Provider NameBrant T Mccall
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1023505757
PECOS PAC ID: 0840696738
Enrollment ID: I20210831003845
Provider NameTyler Wayne White
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1740954825
PECOS PAC ID: 6901202845
Enrollment ID: I20210901001886
Provider NameTyler Reed Phillips
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1164910592
PECOS PAC ID: 0840546511
Enrollment ID: I20210923002343
Provider NameTravis M Griffiths
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1619467610
PECOS PAC ID: 9739437286
Enrollment ID: I20211026002232
Provider NameBarbra Lynn Caldwell
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1417598574
PECOS PAC ID: 9234520776
Enrollment ID: I20211217000441

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.