Mind Mood Pain – Pain Medicine (Anesthesiology) Physician, NPI 1215328547
Pain Medicine (Anesthesiology) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Mind Mood Pain
PO BOX 108835
OKLAHOMA CITY, OK 731018835
Phone: (405) 775-9350
Fax: (405) 775-9360
Type: Mailing
15132 Traditions Blvd
Edmond, OK 730131182
Phone: (405) 703-0937
Fax: (888) 290-8567
Type: Location
1703 Professional Cir Ste 101
Yukon, OK 730996497
Phone: (405) 717-7955
Fax: (888) 290-8567
Type: Location
1109 SW 30TH CT STE A
MOORE, OK 731602887
Phone: (405) 703-0937
Fax: (888) 290-8567
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: 2016-08-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-08-31 (1013 days ago).
Enrollment records
1
Earliest due date
2023-08-31
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 |
|---|---|---|---|---|
| O20160822002224 | O | Clinic/Group Practice | OK | 2023-08-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 73101)
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