PROVECTUS DIAGNOSTICS LLC
NPI 1104213156
Clinical Medical Laboratory in Tulsa, OK

Active since April 16, 2015
4150 S 100TH EAST AVE, SUITE 105, TULSA, OK 74146(918) 949-4526(918) 949-4549 Get Directions Write a Review

NPPES record last updated: October 29, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 15, 2023, Jul 15, 2021 (2 updates tracked since 2021).

About Provectus Diagnostics Llc NPPES

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

PROVECTUS DIAGNOSTICS LLC (NPI 1104213156) is a healthcare organization registered as a clinical medical laboratory in Tulsa, Oklahoma and active in the NPI registry since April 2015. The organization lists Steven T Mccormack, Owner/ceo, as its authorized official.

NPPES Registry Identity

NPI1104213156
Entity TypeOrganization
Primary Taxonomy291U00000X
Legal Business NamePROVECTUS DIAGNOSTICS LLC
Location Address4150 S 100TH EAST AVE, SUITE 105Tulsa, OK 74146-3650
Mailing Address4150 S 100th East Ave, Suite 105Tulsa, OK 74146-3650 · (918) 949-4526 · Fax (918) 949-4549
Fax(918) 949-4549
Organization SubpartNo
Authorized OfficialSteven T MccormackOwner/ceo · (626) 244-8200
Enumeration DateApril 16, 2015
Last NPPES UpdateOctober 29, 20242 updates tracked since enumeration
NPPES CertifiedOctober 29, 2024
✔ NPI 1104213156 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinical Medical LaboratoryLaboratories
Taxonomy Code291U00000X
Definition
(1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology.
4150 S 100TH EAST AVE, Tulsa, OK 74146

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Provectus Diagnostics Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

18

Medicare enrollment records show 18 clinicians reassign Medicare billing to Provectus Diagnostics LLC, which bills Medicare for the services they deliver. Of these, 8 practice within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 7

Nurse Practitioner7
Certified Registered Nurse Anesthetist (CRNA)4
Family Practice3
Anesthesiology1
Diagnostic Radiology1
General Practice1
Interventional Radiology1

Clinicians, nearest first (18)

Nurse Practitioner
NPI 1205485984
4750 S GARNETT RD STE C
Tulsa, OK 74146
(539) 812-2106
✔ PECOS✔ Accepts Medicare0.4 mi
Nurse Practitioner
NPI 1336738293
4110 S 100TH EAST AVE STE 201
Tulsa, OK 74146
(918) 857-7246
✔ PECOS✔ Accepts Medicare0.7 mi
Anesthesiology
NPI 1649217746
8801 S 101ST EAST AVE
Tulsa, OK 74133
(918) 294-4915
✔ PECOS✔ Accepts Medicare4.4 mi
General Practice
NPI 1851974653
6717 S YALE AVE STE 210
Tulsa, OK 74136
(918) 675-0068
✔ PECOS✔ Accepts Medicare4.4 mi
Nurse Practitioner
NPI 1659763845
8921 S MINGO RD
Tulsa, OK 74133
(888) 397-8387
✔ PECOS4.5 mi
Certified Registered Nurse Anesthetist (CRNA)
NPI 1285875443
6130 E 81ST ST
Tulsa, OK 74137
(918) 401-1002
✔ Accepts Medicare4.6 mi
Nurse Practitioner
NPI 1902662604
6130 E 81ST ST
Tulsa, OK 74137
(918) 401-1002
✔ PECOS✔ Accepts Medicare4.6 mi
Nurse Practitioner
NPI 1942882691
6802 S OLYMPIA AVE STE 100
Tulsa, OK 74132
(918) 447-9300
✔ PECOS✔ Accepts Medicare8.7 mi
Nurse Practitioner
NPI 1548852213
1609 W BROADWAY ST
Collinsville, OK 74021
(918) 864-5475
✔ PECOS✔ Accepts Medicare18 mi
Family Practice
NPI 1639332042
410 E CHEROKEE ST
Wagoner, OK 74467
(918) 485-5591
✔ PECOS✔ Accepts Medicare28 mi
Nurse Practitioner
NPI 1528634573
4110 S 100TH EAST AVE STE 201
Tulsa, OK 74146
(724) 691-8857
✔ PECOS✔ Accepts Medicare48 mi
Certified Registered Nurse Anesthetist (CRNA)
NPI 1689428658
100 MCDOUGAL DR
Holdenville, OK 74848
(405) 379-4259
76 mi
Family Practice
NPI 1205814449
154 S MCCORD RD
Ponca City, OK 74604
(580) 747-9039
✔ PECOS✔ Accepts Medicare76 mi
Interventional Radiology
NPI 1598753618
1000 N LINCOLN BLVD STE 4000
Oklahoma City, OK 73104
(405) 271-4912
✔ PECOS✔ Accepts Medicare102 mi
Certified Registered Nurse Anesthetist (CRNA)
NPI 1285466425
1301 E LINCOLN RD
Idabel, OK 74745
(580) 286-7623
✔ Accepts Medicare164 mi
Certified Registered Nurse Anesthetist (CRNA)
NPI 1043603038
900 17TH ST
Woodward, OK 73801
(580) 256-5511
✔ Accepts Medicare199 mi
Diagnostic Radiology
NPI 1023000338
17310 WRIGHT ST STE 103
Omaha, NE 68130
(833) 228-6889
✔ PECOS355 mi
Family Practice
NPI 1063117745
2450 SW PERKINS AVE
Pendleton, OR 97801
(541) 276-1700
✔ PECOS✔ Accepts Medicare1,364 mi

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

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms G0480
A definitive drug test is a detailed examination that can identify specific drugs in your system, even closely related ones. Techniques like GC/MS and LC/MS are used for high precision. This helps ensure accurate results for your safety and health.
17 services17 patients

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 Provectus Diagnostics LLC's NPI number?

The NPI number for Provectus Diagnostics LLC is 1104213156. It was assigned to this organization in the NPPES registry on April 16, 2015.

Where is Provectus Diagnostics LLC located?

Provectus Diagnostics LLC is located at 4150 S 100th East Ave Suite 105, Tulsa, OK 74146. The listed phone number is (918) 949-4526.

What is Provectus Diagnostics LLC's specialty?

The primary specialty registered for this NPI is Clinical Medical Laboratory with taxonomy code 291U00000X.

Is Provectus Diagnostics LLC enrolled in Medicare?

Yes. Provectus Diagnostics LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Provectus Diagnostics LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 18 clinicians in 7 Medicare specialties reassign their Medicare billing to Provectus Diagnostics LLC. A 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 the clinician's services. The largest specialties are Nurse Practitioner (7), Certified Registered Nurse Anesthetist (CRNA) (4) and Family Practice (3). Of these, 8 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Provectus Diagnostics LLC accept?

Health plans from Mending Health list Provectus Diagnostics LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Provectus Diagnostics LLC was last updated on October 29, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months 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.