| NPI |
1073605275 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
| Entity Type Code |
1 |
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
| Provider Last Name Legal Name |
SWANSON |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
| Provider First Name |
KEITH |
The first name of the provider, if the provider
is an individual. |
| Provider Middle Name |
ALAN |
The middle name of the provider, if the provider
is an individual. |
| Provider Name Prefix Text |
DR. |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
| Provider Credential Text |
PHARM.D., CGP |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
| Provider First Line Business Practice Location Address |
1110 N STONEWALL |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
| Provider Second Line Business Practice Location Address |
BOX 26901 |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
| Provider Business Practice Location Address City Name |
OKLAHOMA CITY |
The city name in the location address of the provider being identified. |
| Provider Business Practice Location Address State Name |
OK |
The State code in the location of the provider
being identified. |
| Provider Business Practice Location Address Postal Code |
731900001 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Telephone Number |
4052716878 |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Provider Business Practice Location Address Fax Number |
4052716430 |
The fax number associated with the location
address of the provider being identified. |
| Provider Enumeration Date |
9/28/2006 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date |
7/25/2007 |
The date that a record was last updated or changed. |
| Provider Gender Code |
M |
The code designating the provider’s gender if the provider is a person. |
| Healthcare Provider Taxonomy Code 1 |
183500000X |
The code designating the provider’s gender if the provider is a person. |
| Provider License Number 1 |
9909 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider License Number State Code 1 |
NE |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
| Healthcare Provider Taxonomy Code 2 |
1835P1200X |
|
| Provider License Number 2 |
12152 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider License Number State Code 2 |
OK |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Healthcare Provider Primary Taxonomy Switch 2 |
N |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Healthcare Provider Taxonomy Code 3 |
1835G0303X |
|
| Provider License Number 3 |
12152 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider License Number State Code 3 |
OK |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Healthcare Provider Primary Taxonomy Switch 3 |
Y |
|
| Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |