GARY FENNEMA (D.O.) – Emergency Medicine Physician, NPI 1578003992
Emergency Medicine Physician
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
747 EMERGENCY MEDICINE in OK
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Provider Addresses for GARY FENNEMA (D.O.)
2622 W 112TH PL S
JENKS, OK 740372127
Phone: (918) 691-4601
Type: Mailing
9724, South 72nd East Avenue, Windsor Woods, Tulsa, Tulsa County, Oklahoma, 74133, United States
TULSA, OK 741336027
Phone: (918) 691-4601
Type: Mailing
Oklahoma State University Medical Center, 744, West 9th Street, Crosbie Heights, Tulsa, Tulsa County, Oklahoma, 74127, United States
TULSA, OK 741279020
Phone: (918) 599-1000
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: 2019-11-19
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 |
|---|---|---|---|---|
| I20191119003044 | I | Emergency Medicine | 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 |
|---|---|---|---|---|
| 99284 | Emergency department visit with moderate level of medical decision making | 58 | 51 | $0 |
| 99285 | Emergency department visit with high level of medical decision making | 57 | 56 | $0 |
| 93010 | Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | 34 | 33 | $0 |
| 99283 | Emergency department visit with low level of medical decision making | 28 | 28 | $0 |
Insurance plans in this area (ZIP 74037)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine, Critical Care (Intensivists), Nephrology | OK | |
| Hematology/Oncology, Internal Medicine | TX | |
| Nephrology, Internal Medicine | OKLAHOMA | |
| Certified Registered Nurse Anesthetist (Crna) | TX | |
| Cardiovascular Disease (Cardiology), Internal Medicine | OK | |
| R H E U M A T O L O G Y | NY | |
| Nurse Practitioner | OK | |
| Emergency Medicine | OK | |
| N E U R O S U R G E R Y | KS | |
| Nurse Practitioner | OK |
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