JACY D DONNELLY (DO) – Psychiatry Physician, NPI 1457937138
Psychiatry Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
363 PSYCHIATRY in OK
Provider Addresses for JACY D DONNELLY (DO)
512 W ATLANTA ST
BROKEN ARROW, OK 740127004
Phone: (918) 370-4461
Fax: (918) 512-4723
Type: Location
5310 E 31ST ST STE LL
TULSA, OK 74135
Phone: (918) 236-4000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $33.
Total Amount is formed as General ($33) + Research ($0) + Ownership ($0) = $33.
Last reported payment date: 2024-03-13 • Largest payer in this snapshot: Corium, LLC ($33).
Total Amount
$33
General + Research + Ownership
Payments
1
Total payment records
General Amount
$33
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-03-13
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Corium, LLC | $33 |
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: 2025-09-24
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 |
|---|---|---|---|---|
| I20250924004702 | I | Psychiatry | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 74012)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OK | |
| - | OK | |
| Nurse Practitioner | OK | |
| Clinical Social Worker | OK | |
| P S Y C H I A T R Y | OK | |
| Mental Health Counselor | OK | |
| Clinical Social Worker | OK | |
| Nurse Practitioner | OK | |
| Clinical Social Worker | OK | |
| Clinical Social Worker | OK |
Reviews
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