TRACY ADELLE KIDWELL (D.O.) – Family Medicine Physician, NPI 1033197496
Family Medicine Physician
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Profile Insights
NPPES metrics only — not quality of care.
1,775 FAMILY PRACTICE in OK
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Provider Addresses for TRACY ADELLE KIDWELL (D.O.)
North Kickapoo Avenue, Shawnee, Pottawatomie County, Oklahoma, 74804, United States
SUITE 124
SHAWNEE, OK 748041707
Phone: (405) 273-6383
Fax: (405) 214-1074
Type: Location
3700 N Kickapoo Ave
Suite 124
Shawnee, OK 748041707
Phone: (405) 273-6383
Fax: (405) 214-1074
Type: Location
1800, South Douglas Boulevard, Midwest City, Oklahoma County, Oklahoma, 73130, United States
MIDWEST CITY, OK 731306224
Phone:
Type: Mailing
1800 S DOUGLAS BLVD
MIDWEST CITY, OK 731306224
Phone: (405) 741-7722
Fax: (405) 741-7757
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2012-08-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20120829000077 | I | Family Practice | OK | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 276 | 150 | $0 |
| 99497 | Advance care planning, first 30 minutes | 179 | 179 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 158 | 158 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 135 | 109 | $0 |
| G0008 | Administration of influenza virus vaccine | 51 | 49 | $0 |
Insurance plans in this area (ZIP 74804)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | OK | |
| Internal Medicine, Pediatric Medicine | OK | |
| U R O L O G Y | OK | |
| Clinical Social Worker | OK | |
| Physician Assistant | OK | |
| Physician Assistant | OK | |
| Orthopedic Surgery | OK | |
| Family Practice | OK | |
| Family Practice | OK | |
| Nurse Practitioner | OK |
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