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PRAIRIE GARDENS MEDICAL LLC
NPI 1689280067
General Practice in Oklahoma City, OK

Active since September 21, 2020
1213 NW 122ND ST STE 401, OKLAHOMA CITY, OK 73114(405) 962-9123(405) 962-8125 Get Directions Write a Review

NPPES record last updated: September 29, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 29, 2020, Sep 21, 2020 (2 updates tracked since 2020).

About Prairie Gardens Medical Llc NPPES

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

PRAIRIE GARDENS MEDICAL LLC (NPI 1689280067) is a healthcare organization registered as a general practice in Oklahoma City, Oklahoma and active in the NPI registry since September 2020. The organization lists Dianne Genene Tupper, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1689280067
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NamePRAIRIE GARDENS MEDICAL LLC
Location Address1213 NW 122ND ST STE 401Oklahoma City, OK 73114-7000
Mailing Address175 Lary LnGuthrie, OK 73044-6542 · (405) 962-8123 · Fax (405) 962-8125
Phone(405) 962-9123
Fax(405) 962-8125
Organization SubpartNo
Authorized OfficialDianne Genene TupperPractice Manager · (405) 742-8898
Enumeration DateSeptember 21, 2020
Last NPPES UpdateSeptember 29, 20202 updates tracked since enumeration
NPPES CertifiedSeptember 29, 2020
✔ NPI 1689280067 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
1213 NW 122ND ST STE 401, Oklahoma City, OK 73114
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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)

Prairie Gardens Medical Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

8

Medicare enrollment records show 8 clinicians reassign Medicare billing to Prairie Gardens Medical LLC, which bills Medicare for the services they deliver. Of these, 6 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (8)

Daniel Jones, MD
Orthopedic Surgery
NPI 1538169883
12301 N WESTERN AVE STE 101
Oklahoma City, OK 73114
(405) 962-8123
✔ PECOS0.1 mi
Lan-Uyen Nguyen
Family Practice
NPI 1174152680
12301 N WESTERN AVE STE 101
Oklahoma City, OK 73114
(405) 962-8123
✔ PECOS✔ Accepts Medicare0.1 mi
Joel Tupper, MD
Orthopedic Surgery
NPI 1427083609
12301 N WESTERN AVE STE 101
Oklahoma City, OK 73114
(405) 757-8338
✔ PECOS✔ Accepts Medicare0.1 mi
Melinda Courcier, R.P.T.
Physical Therapist in Private Practice
NPI 1831337955
14017 N EASTERN AVE
Edmond, OK 73013
(405) 478-5333
✔ Accepts Medicare3.3 mi
Liem Trang, D.O.
Pain Management
NPI 1619084738
3328 N CLASSEN BLVD
Oklahoma City, OK 73118
(405) 524-5200
✔ PECOS✔ Accepts Medicare6.3 mi
Matthew Jared, M.D.
Family Practice
NPI 1205060183
1000 N LEE AVE ROOM 4404
Oklahoma City, OK 73102
(405) 272-6406
✔ PECOS✔ Accepts Medicare8.1 mi
Susan Alfert
Nurse Practitioner
NPI 1457831943
2802 N KICKAPOO AVE
Shawnee, OK 74804
(405) 214-6441
✔ PECOS✔ Accepts Medicare38 mi
William Smith, DPM
Podiatry
NPI 1629050364
1627 N KICKAPOO AVE
Shawnee, OK 74804
(405) 275-8234
✔ PECOS38 mi

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

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 Prairie Gardens Medical LLC's NPI number?

The NPI number for Prairie Gardens Medical LLC is 1689280067. It was assigned to this organization in the NPPES registry on September 21, 2020.

Where is Prairie Gardens Medical LLC located?

Prairie Gardens Medical LLC is located at 1213 NW 122nd St Ste 401, Oklahoma City, OK 73114. The listed phone number is (405) 962-9123.

What is Prairie Gardens Medical LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Prairie Gardens Medical LLC enrolled in Medicare?

Yes. Prairie Gardens Medical LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Prairie Gardens Medical LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians reassign their Medicare billing to Prairie Gardens Medical LLC, in Family Practice, Nurse Practitioner, Orthopedic Surgery, Pain Management, Physical Therapist in Private Practice and 1 other specialty. 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. Of these, 6 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Prairie Gardens Medical LLC was last updated on September 29, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.