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DR. JACK WADE LETHERMON DNP PMHNP
NPI 1316722119
Nurse Practitioner - Psychiatric/Mental Health in Claremore, OK

Active since August 29, 2023PECOS EnrolledAccepts Medicare Assignment
505 W 1ST ST, CLAREMORE, OK 74017(918) 606-5225 Get Directions Write a Review

NPPES record last updated: April 8, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Apr 8, 2024, Aug 29, 2023 (2 updates tracked since 2023).

About Dr. Jack Wade Lethermon Dnp Pmhnp NPPES

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

DR. JACK WADE LETHERMON DNP PMHNP (NPI 1316722119) is an individual psychiatric/mental health provider in Claremore, Oklahoma, licensed in Oklahoma (214986) and active in the NPI registry since August 2023. He is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1316722119
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameDR. JACK WADE LETHERMONCredential: DNP PMHNP
Location Address505 W 1ST STClaremore, OK 74017-7803
Mailing Address904 S Division StSapulpa, OK 74066-5706 · (918) 606-5225
Phone(918) 606-5225
Sole ProprietorNo
Medical School CMSOtherGraduated 2023
Enumeration DateAugust 29, 2023
Last NPPES UpdateApril 8, 20242 updates tracked since enumeration
NPPES CertifiedApril 8, 2024
✔ NPI 1316722119 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in OK · 214986
505 W 1ST ST, Claremore, OK 74017
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Oklahoma, Mending Health, Oscar Insurance Company and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Jack Wade Lethermon Dnp Pmhnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9739535501
PECOS Enrollment IDI20231031001416
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 Reassignments

2

Medicare enrollment records show Jack Lethermon reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

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
Lighthouse Behavioral Wellness Centers
169 mi
Mental Health (Including Community Mental Health Center)
2530 S COMMERCE, BLDG A
Ardmore, OK 73401
  • Reassigned Medicare billing, Oklahoma enrollment
  • 93 clinicians in this Medicare group
NPI 1881884807 (580) 223-5070

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 74017 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.46 typical visit price
range $53.00 – $162.61
Typical copayment $20.61 (range $13.25 – $40.65)
Most-billed visit code 99203
Established Patient
$94.27 typical visit price
range $16.68 – $132.40
Typical copayment $23.56 (range $4.17 – $33.10)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 7

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

SANDRA MWANSA LPC-C
Counselor (Mental Health)
505 W 1ST ST
CLAREMORE, OK 74017
Rogers County (918) 280-8360
MELISSA DAWN CRAWFORD MA, LPC
Counselor
505 W 1ST ST
CLAREMORE, OK 74017
Rogers County (918) 280-8360
MEGEN RHINE CONSULTING LLC
Counselor (Mental Health)
505 W 1ST ST
CLAREMORE, OK 74017
Rogers County (918) 280-8360
KYLE MORRISON MS, LPC
Counselor (Mental Health)
505 W 1ST ST
CLAREMORE, OK 74017
Rogers County (918) 280-8360
HEATHER EARLY LPC-C
Counselor (Mental Health)
505 W 1ST ST
CLAREMORE, OK 74017
Rogers County (918) 280-8360
MEGEN RHINE MS
Counselor (Mental Health)
505 W 1ST ST
CLAREMORE, OK 74017
Rogers County (918) 280-8360
DESIREE JONES LPC-S
Counselor (Mental Health)
505 W 1ST ST
CLAREMORE, OK 74017
Rogers County (720) 593-9216

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 Jack Lethermon's NPI number?

The NPI number for Jack Lethermon is 1316722119. It was assigned to this individual provider in the NPPES registry on August 29, 2023.

Where is Jack Lethermon located?

Jack Lethermon practices at 505 W 1st St, Claremore, OK 74017. The listed phone number is (918) 606-5225.

What is Jack Lethermon's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Jack Lethermon enrolled in Medicare?

Yes. Jack Lethermon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Jack Lethermon's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jack Lethermon reassigns Medicare benefits to 2 organizations: Creek Nation Hospital & Clinics (Muskogee, OK) and Lighthouse Behavioral Wellness Centers (Ardmore, OK). Each 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 Jack Lethermon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jack Lethermon accept?

Health plans from Blue Cross and Blue Shield of Oklahoma, Mending Health, Oscar Insurance Company and UnitedHealthcare list Jack Lethermon 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 Jack Lethermon was last updated on April 8, 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.