MRS. MANDIE LEIGH RENNER CCNS
NPI 1760630131
Nurse Practitioner - Neonatal, Critical Care in Tulsa, OK

Q: What is Mandie Renner's NPI number?

The NPI number for Mandie Renner is 1760630131. It was assigned to this individual provider in the NPPES registry on August 28, 2008.

Q: What is Mandie Renner's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Neonatal, Critical Care, with taxonomy code 363LN0005X.

Q: When was this NPI record last updated?

The NPPES record for Mandie Renner was last updated on March 6, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.

Active since August 28, 2008PECOS Enrolled

1120 S UTICA AVE STE 2123, TULSA, OK 74104(918) 579-5402(918) 579-5404 Get Directions Write a Review

NPPES record last updated: March 6, 2019. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 6, 2019, Dec 15, 2015 (2 updates tracked since 2015).

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About Mrs. Mandie Leigh Renner Ccns NPPES

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

MRS. MANDIE LEIGH RENNER CCNS (NPI 1760630131) is an individual neonatal, critical care provider in Tulsa, Oklahoma, licensed in Oklahoma (80137) and active in the NPI registry since August 2008. She is enrolled in Medicare PECOS and maintains a secondary practice location in Tulsa.

NPPES Registry Identity

NPI1760630131

Entity TypeIndividualFemale

Primary Taxonomy363LN0005X

Provider Legal NameMRS. MANDIE LEIGH RENNERCredential: CCNS

Location Address1120 S UTICA AVE STE 2123Tulsa, OK 74104

Mailing Address1120 S Utica Ave Ste 2123Tulsa, OK 74104-4012 · (189) 579-5402 · Fax (918) 579-5404

Phone(918) 579-5402

Fax(918) 579-5404

Sole ProprietorNo

Enumeration DateAugust 28, 2008

Last NPPES UpdateMarch 6, 20192 updates tracked since enumeration

✔ NPI 1760630131 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Neonatal, Critical CarePhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LN0005X

License✔ Licensed in OK · 80137

Also ListedClinical Nurse Specialist · NeonatalTaxonomy 364SN0000X · License 81378 (OK)

1120 S UTICA AVE STE 2123, Tulsa, OK 74104

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Secondary Practice Location 1

Location 18607 E. 104th StTulsa, OK 74113 · Phone (918) 808-1881

Accepted Insurance

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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Mandie Leigh Renner Ccns is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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

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

Northwest Benton County Physician Services LLC

99 mi

Family Medicine

1102 NW LOWES AVE STE 2
Bentonville, AR 72712

Reassigned Medicare billing, Arkansas enrollment
136 clinicians in this Medicare group

NPI 1871553073 (479) 254-8563

Northwest Physicians LLC

100 mi

Obstetrics

4077 ELM SPRINGS RD STE 105
Springdale, AR 72762

Reassigned Medicare billing, Arkansas enrollment
115 clinicians in this Medicare group

NPI 1194768721 (479) 757-5301

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 74104 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.

COURTNEY AMBER MORRIS

Nurse Practitioner (Neonatal, Critical Care)