JEAN I KEDDISSI (MD) – Pulmonary Disease Physician, NPI 1568430718
Pulmonary Disease Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
143 CRITICAL CARE (INTENSIVISTS) in OK
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Provider Addresses for JEAN I KEDDISSI (MD)
1122, Northeast 13th Street, Oklahoma City, Oklahoma County, Oklahoma, 73117, United States
ORI 236
OKLAHOMA CITY, OK 731171039
Phone: (405) 271-1515
Type: Mailing
OU Physicians, 825, Northeast 10th Street, Oklahoma City, Oklahoma County, Oklahoma, 73104, United States
OUPB 2500
OKLAHOMA CITY, OK 731045417
Phone: (405) 271-7001
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: 2005-08-11
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 |
|---|---|---|---|---|
| I20050811000138 | I | Pulmonary Disease | 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 73117)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Diagnostic Radiology | OK | |
| O P H T H A L M O L O G Y | OK | |
| Certified Registered Nurse Anesthetist (Crna) | OK | |
| R H E U M A T O L O G Y | OK | |
| Nurse Practitioner | OK | |
| Certified Registered Nurse Anesthetist (Crna) | OK | |
| Certified Registered Nurse Anesthetist (Crna) | OK | |
| Family Practice, Hospitalist | OK | |
| Medical Oncology | RI | |
| Clinical Social Worker | OK |
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