1. Home
  2. Directory
  3. Oklahoma
  4. Tulsa
  5. Student In An Organized Health Care Education Training Program
  6. NPI Profile

KENDALL FAGAN DO
NPI 1053006049
Student in an Organized Health Care Education/Training Program in Tulsa, OK

Active since April 06, 2023PECOS Enrolled
4502 E 41ST ST, TULSA, OK 74135(530) 526-1596 Get Directions Write a Review

NPPES record last updated: July 28, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 28, 2024, Apr 6, 2023 (2 updates tracked since 2023).

About Kendall Fagan Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENDALL FAGAN DO (NPI 1053006049) is an individual student in an organized health care education/training program in Tulsa, Oklahoma and active in the NPI registry since April 2023. She is enrolled in Medicare PECOS, is affiliated with Creek Nation Community Hospital, and is a graduate of Other (2024).

NPPES Registry Identity

NPI1053006049
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameKENDALL FAGANCredential: DO
Location Address4502 E 41ST STTulsa, OK 74135-2536
Mailing Address980 12th StIdaho Falls, ID 83404-5051
Phone(530) 526-1596
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateApril 6, 2023
Last NPPES UpdateJuly 28, 20242 updates tracked since enumeration
NPPES CertifiedJuly 28, 2024
✔ NPI 1053006049 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
4502 E 41ST ST, Tulsa, OK 74135
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kendall Fagan Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8224506209
PECOS Enrollment IDI20260508000290
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kendall Fagan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Creek Nation Hospital & Clinics
39 mi
Clinic/Center
2900 N MAIN ST
Muskogee, OK 74401
  • Reassigned Medicare billing, Texas enrollment
  • 655 clinicians in this Medicare group
NPI 1922873611 (918) 346-7833

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Creek Nation Community Hospital

Critical Access Hospitals · Okemah, OK
OwnershipTribal
CMS Certification Number371333
Location1800 E CoplinOkemah, OK 74859 · Okfuskee County
Emergency services

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. MICHAEL DANIEL FIGUEIREDO MD
Emergency Medicine
4502 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 619-4400
PETER MADDEN MD
Internal Medicine
4502 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 619-4400
AMNA OBAID
Student in an Organized Health Care Education/Training Program
4502 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 619-4400
LAMAURI FRANKLIN
Student in an Organized Health Care Education/Training Program
4502 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 660-3842
SAI ATLURI MD
Internal Medicine
4502 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 619-4888
HAIDEN REECE PETERSON
Student in an Organized Health Care Education/Training Program
4502 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 660-3842
RILEY SHULER POLK MD
Emergency Medicine
4502 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 579-2367
DR. STEPHEN HODGES THOMAS MD
Emergency Medicine
4502 E 41ST ST
TULSA, OK 74135
Tulsa County (918) 660-3831

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kendall Fagan's NPI number?

The NPI number for Kendall Fagan is 1053006049. It was assigned to this individual provider in the NPPES registry on April 6, 2023.

Where is Kendall Fagan located?

Kendall Fagan practices at 4502 E 41st St, Tulsa, OK 74135. The listed phone number is (530) 526-1596.

What is Kendall Fagan's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Kendall Fagan enrolled in Medicare?

Yes. Kendall Fagan is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kendall Fagan's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kendall Fagan reassigns Medicare benefits to Creek Nation Hospital & Clinics (Muskogee, OK). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kendall Fagan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Kendall Fagan affiliated with any hospitals?

According to CMS data, Kendall Fagan is affiliated with Creek Nation Community Hospital.

When was this NPI record last updated?

The NPPES record for Kendall Fagan was last updated on July 28, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.