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OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE LLC
NPI 1104291236
Dermatology - MOHS-Micrographic Surgery in Broken Arrow, OK

Active since December 01, 2015CLIA Certified · 4 labs
800 W BOISE CIR STE 400, BROKEN ARROW, OK 74012(918) 307-0215(918) 250-7669 Get Directions Write a Review

NPPES record last updated: August 11, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 11, 2025, Feb 18, 2020, Dec 1, 2015 (3 updates tracked since 2015).

About Oklahoma Cancer Specialists And Research Institute Llc NPPES

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

OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE LLC (NPI 1104291236) is a healthcare organization registered as a mohs-micrographic surgery in Broken Arrow, Oklahoma and active in the NPI registry since December 2015. The organization holds 4 active CLIA laboratory certificates and lists Daron G. Street, President, as its authorized official.

NPPES Registry Identity

NPI1104291236
Entity TypeOrganization
Primary Taxonomy207ND0101X
Legal Business NameOKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE LLC
Location Address800 W BOISE CIR STE 400Broken Arrow, OK 74012-4974
Mailing Address12697 E 51st StTulsa, OK 74146-6236 · (918) 307-0215 · Fax (918) 250-7669
Phone(918) 307-0215
Fax(918) 250-7669
Organization SubpartNo
Authorized OfficialDaron G. StreetPresident · (918) 505-3200
Enumeration DateDecember 1, 2015
Last NPPES UpdateAugust 11, 20253 updates tracked since enumeration
NPPES CertifiedAugust 11, 2025
✔ NPI 1104291236 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207ND0101X
Definition
The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X
800 W BOISE CIR STE 400, Broken Arrow, OK 74012
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Oklahoma Cancer Specialists And Research Institute Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

67

Medicare enrollment records show 67 clinicians reassign Medicare billing to Oklahoma Cancer Specialists And Research Institute LLC, which bills Medicare for the services they deliver. Of these, 48 practice within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 15

Nurse Practitioner21
Medical Oncology11
Gynecological Oncology6
Dermatology5
Hematology/Oncology5
Radiation Oncology5
Certified Clinical Nurse Specialist (CNS)4
Diagnostic Radiology3
7 other specialties7

Nearest to this location (20)

See all 67
Janelle Pavlis, M.D.
Dermatology
NPI 1447667613
800 W BOISE CIR STE 400
Broken Arrow, OK 74012
(918) 307-0215
✔ PECOS✔ Accepts Medicare0.1 mi
Travis Brachtenbach, DO
Medical Oncology
NPI 1043839012
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3200
✔ PECOS✔ Accepts Medicare2.1 mi
Cheyenne Hilgenberg, MD
Dermatology
NPI 1831777267
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3200
✔ PECOS✔ Accepts Medicare2.1 mi
Stephanie Adame, APRN
Nurse Practitioner
NPI 1003402918
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3200
✔ PECOS✔ Accepts Medicare2.1 mi
Daron Street, M.D.
Gynecological Oncology
NPI 1083656912
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3200
✔ PECOS✔ Accepts Medicare2.1 mi
Kevin Weibel, D.O.
Hematology/Oncology
NPI 1104864016
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3200
✔ PECOS2.1 mi
Basil Bakir
Medical Oncology
NPI 1932765088
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3200
✔ PECOS✔ Accepts Medicare2.2 mi
Lisa Bloxham, APRN-CNP
Nurse Practitioner
NPI 1366904740
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3200
✔ PECOS✔ Accepts Medicare2.2 mi
Steven Buck, D.O.
Medical Oncology
NPI 1154373835
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3200
✔ PECOS2.2 mi
Andrea Carpenter, APRN
Nurse Practitioner
NPI 1336794650
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3200
✔ PECOS✔ Accepts Medicare2.2 mi
Jason Davis
Clinical Social Worker
NPI 1366865545
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3259
✔ PECOS✔ Accepts Medicare2.2 mi
Michael Gold, MD
Gynecological Oncology
NPI 1376511956
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3200
✔ PECOS✔ Accepts Medicare2.2 mi
Alfred Jenkins, MD
Gynecological Oncology
NPI 1487686200
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3200
✔ PECOS✔ Accepts Medicare2.2 mi
Libbe Marquez, APRN AGCNS-BC
Certified Clinical Nurse Specialist (CNS)
NPI 1336719400
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3200
✔ PECOS✔ Accepts Medicare2.2 mi
Ali Moussa, M.D.
Hematology/Oncology
NPI 1548207814
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3200
✔ PECOS✔ Accepts Medicare2.2 mi
Mykhanh Nguyen, M.D.
Radiation Oncology
NPI 1508820606
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3200
✔ PECOS✔ Accepts Medicare2.2 mi
Amanda Rausch, RDN
Registered Dietitian or Nutrition Professional
NPI 1619571338
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-3200
2.2 mi
Caleb Scheckel, D.O.
Hematology/Oncology
NPI 1447606348
12697 E 51ST ST
Tulsa, OK 74146
(918) 505-5320
✔ PECOS✔ Accepts Medicare2.2 mi
Sara White, MSN, APRN-CNS
Certified Clinical Nurse Specialist (CNS)
NPI 1851773444
12697 E 51ST ST
Tulsa, OK 74146
(918) 499-2109
✔ PECOS✔ Accepts Medicare2.2 mi
Edward Yob, DO
Dermatology
NPI 1205825619
8803 S 101ST EAST AVE SUITE 335
Tulsa, OK 74133
(918) 307-0215
✔ PECOS4.5 mi
See all 67 clinicians

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

CLIA Laboratory Certificates CMS CLIA 4

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 37D2345623

Oklahoma Cancer Specialists And Research Institute · Tulsa, OK
Active · expires Jun 14, 2028
CLIA Number37D2345623
Laboratory TypePhysician Office
Certificate Effective DateJune 15, 2026
Certificate Expiration DateJune 14, 2028
Laboratory DirectorJennifer C. Freeman
Laboratory Phone(915) 505-3200
Laboratory LocationOklahoma Cancer Specialists And Research Institute12697 E 51st St So, Tulsa, OK 74146
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Accreditation 37D0859740

Oklahoma Cancer Specialist & Research Institute LLC · Tulsa, OK
Active · expires Dec 22, 2027
CLIA Number37D0859740
Laboratory TypePhysician Office
Certificate Effective DateDecember 23, 2025
Certificate Expiration DateDecember 22, 2027
Laboratory DirectorAdam Hoffhines
Laboratory Phone(918) 505-3200
Laboratory LocationOklahoma Cancer Specialist & Research Institute LLC12697 E 51st Street South, Tulsa, OK 74146
CLIA data matches this NPI record on: Address Phone
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Waiver 37D1092968

Oklahoma Cancer Specialist & Research Institute LLC · Tulsa, OK
Active · expires Dec 7, 2026
CLIA Number37D1092968
Laboratory TypePhysician Office
Certificate Effective DateDecember 8, 2024
Certificate Expiration DateDecember 7, 2026
Laboratory DirectorMark R. Olsen
Laboratory Phone(918) 505-3200
Laboratory LocationOklahoma Cancer Specialist & Research Institute LLC12697 E 51st Street South, Tulsa, OK 74146
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 37D0681101

Oklahoma Cancer Specialist & Research Institute Skin Cancer Center · Broken Arrow, OK
Active · expires Mar 28, 2028
CLIA Number37D0681101
Laboratory TypePhysician Office
Certificate Effective DateMarch 29, 2026
Certificate Expiration DateMarch 28, 2028
Laboratory DirectorJanelle M. Pavlis
Laboratory Phone(918) 307-0215
Laboratory LocationOklahoma Cancer Specialist & Research Institute Skin Cancer Center800 W. Boise Circle, Suite 400, Broken Arrow, OK 74012
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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 Oklahoma Cancer Specialists And Research Institute LLC's NPI number?

The NPI number for Oklahoma Cancer Specialists And Research Institute LLC is 1104291236. It was assigned to this organization in the NPPES registry on December 1, 2015.

Where is Oklahoma Cancer Specialists And Research Institute LLC located?

Oklahoma Cancer Specialists And Research Institute LLC is located at 800 W Boise Cir Ste 400, Broken Arrow, OK 74012. The listed phone number is (918) 307-0215.

What is Oklahoma Cancer Specialists And Research Institute LLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Oklahoma Cancer Specialists And Research Institute LLC enrolled in Medicare?

Yes. Oklahoma Cancer Specialists And Research Institute LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Oklahoma Cancer Specialists And Research Institute LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 67 clinicians in 15 Medicare specialties reassign their Medicare billing to Oklahoma Cancer Specialists And Research Institute 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 (21), Medical Oncology (11) and Gynecological Oncology (6). Of these, 48 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Oklahoma Cancer Specialists And Research Institute LLC hold CLIA laboratory certificates?

Yes. 4 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Oklahoma Cancer Specialists And Research Institute LLC was last updated on August 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.