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BROKEN ARROW DIAGNOSTIC MEDICINE, PLLC
NPI 1710322672
Family Medicine in Broken Arrow, OK

Active since May 06, 2013CLIA 37D2058894 · Waiver
5050 E KENOSHA ST, BROKEN ARROW, OK 74014(918) 994-5140(918) 994-5150 Get Directions Write a Review

NPPES record last updated: October 8, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 8, 2024, Apr 10, 2023, Apr 14, 2022 (3 updates tracked since 2022).

About Broken Arrow Diagnostic Medicine, Pllc NPPES

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

BROKEN ARROW DIAGNOSTIC MEDICINE, PLLC (NPI 1710322672) is a healthcare organization registered as a family medicine in Broken Arrow, Oklahoma and active in the NPI registry since May 2013. The organization holds a CLIA Waiver certificate valid through May 13, 2027 and lists Jacob Leon Callison, Managing Member, as its authorized official.

NPPES Registry Identity

NPI1710322672
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameBROKEN ARROW DIAGNOSTIC MEDICINE, PLLC
Location Address5050 E KENOSHA STBroken Arrow, OK 74014-6711
Mailing Address5050 E Kenosha StBroken Arrow, OK 74014-6711 · (918) 994-5140 · Fax (918) 994-5150
Phone(918) 994-5140
Fax(918) 994-5150
Organization SubpartNo
Authorized OfficialJacob Leon CallisonManaging Member · (918) 994-5140
Enumeration DateMay 6, 2013
Last NPPES UpdateOctober 8, 20243 updates tracked since enumeration
NPPES CertifiedOctober 8, 2024
✔ NPI 1710322672 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
5050 E KENOSHA ST, Broken Arrow, OK 74014
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Other Identifiers 3

Medicaid200520620AOK
Other1700851052OK · Npi
Other1487885877OK · Npi

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

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 37D2058894

Broken Arrow Diagnostic Medicine · Broken Arrow, OK
Active · expires May 13, 2027
CLIA Number37D2058894
Laboratory TypePhysician Office
Certificate Effective DateMay 14, 2025
Certificate Expiration DateMay 13, 2027
Laboratory DirectorJacob L. Callison
Laboratory Phone(918) 994-5140
Laboratory LocationBroken Arrow Diagnostic Medicine5050 E Kenosha St, Broken Arrow, OK 74014
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

ROBBIE MICHELLE BOLLINGER PA-C
Physician Assistant
5050 E KENOSHA ST
BROKEN ARROW, OK 74014
Wagoner County (918) 994-5140
JACOB LEON CALLISON PA
Physician Assistant
5050 E KENOSHA ST
BROKEN ARROW, OK 74014
Wagoner County (918) 994-5140
TIFFANY TYLER APRN-CNP
Nurse Practitioner (Primary Care)
5050 E KENOSHA ST
BROKEN ARROW, OK 74014
Wagoner County (918) 335-9492

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 Broken Arrow Diagnostic Medicine, PLLC's NPI number?

The NPI number for Broken Arrow Diagnostic Medicine, PLLC is 1710322672. It was assigned to this organization in the NPPES registry on May 6, 2013.

Where is Broken Arrow Diagnostic Medicine, PLLC located?

Broken Arrow Diagnostic Medicine, PLLC is located at 5050 E Kenosha St, Broken Arrow, OK 74014. The listed phone number is (918) 994-5140.

What is Broken Arrow Diagnostic Medicine, PLLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Broken Arrow Diagnostic Medicine, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 37D2058894) is associated with this NPI, valid through May 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Broken Arrow Diagnostic Medicine, PLLC accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan, Ambetter from Superior HealthPlan and Ambetter of Oklahoma list Broken Arrow Diagnostic Medicine, PLLC 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 Broken Arrow Diagnostic Medicine, PLLC was last updated on October 8, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 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.