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Northeastern Health System

Organization Active NPI Rural Health Clinic/Center · Fort Gibson, OK

NPI 1013458652 · NPPES record last updated Apr 6, 2026

Key facts

NPI
1013458652
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
NORTHEASTERN HEALTH SYSTEM
Practice address
104 Lone Oak Cir
Fort Gibson, OK 74434-5001
Phone
(918) 478-2101
Fax
(918) 478-6008
NPI assigned
Mar 15, 2017
Organization subpart
No

Authorized official

Name
Julie Ward
Title
Cfo
Phone
(918) 453-2120

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 6

Organizations that report the same tax identification number in the National Provider Directory.

Facilities connected through Provider of Services related, parent or unit certification numbers.

Practitioners 105

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 105

Affiliated clinicians 335

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 335

Medicare Care Compare: Hospital

Listed as
Northeastern Health System CCN 370089
Overall star rating
★★☆☆☆ 2 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D1096476Ft Gibson Medical Clinic
104 Lone Oak Circle, Fort Gibson, OK 74434		Provider-performed microscopyJun 30, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in OK

Hospital certification: CCN 370089

Legal name
NORTHEASTERN HEALTH SYSTEM
Doing business as
TAHLEQUAH CITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jun 4, 2025
Beds
98
Ownership / control type
Hospital district or authority
Organization structure
Other · Non-profit
Enrollment address
1400 E Downing St
Tahlequah, OK 74464-3324
Other Hospital Practice Location
Hospital subgroups
General

Rural health clinic certification: CCN 378501

Legal name
NORTHEASTERN HEALTH SYSTEM
Doing business as
FORT GIBSON MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 31, 2017
Last certification
Jun 7, 2023
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Jun 3, 1974 in OK
Enrollment address
104 Lone Oak Cir
Fort Gibson, OK 74434-5001
Related CCNs
370089

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
James Berry
Individual 		Corporate Officer
VP		 Sep 1, 2016
Northeastern Health System
Organization · Tahlequah, OK 		Operational/Managerial Control May 1, 2008
Brian Woodliff
Individual 		Corporate Director May 19, 2005
W-2 Managing Employee May 19, 2005
Christine Jankas
Individual 		Corporate Officer
VP Physician Services		 May 14, 2019
Kristen Lemasters
Individual 		W-2 Managing Employee Jul 1, 2022

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tahlequah City Hospital
Tahlequah, OK · CCN 370089		 Hospital Operational/Managerial Control May 1, 2008
Tahlequah City Hospital
Tahlequah, OK · CCN 37S089		 Hospital Operational/Managerial Control Oct 1, 2002
Tahlequah City Hospital
Tahlequah, OK · CCN 37T089		 Hospital Operational/Managerial Control Jan 1, 1974

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20050519001008 OK Part a Provider - Hospital 1456255025 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tahlequah, OK
O20170605000888 OK Part a Provider - Rural Health Clinic 1456255025 Practice locations: Fort Gibson, OK

National Provider Directory

Tax ID family
Northeastern Health System (7 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

104 Lone Oak Cir
Fort Gibson, OK 74434-5001

Mailing address

PO Box 500
Tahlequah, OK 74465-0500
Phone (918) 478-2101

Other names

  • Fort Gibson Medical Clinic Doing business as

Other providers in Fort Gibson, OK

All providers in Fort Gibson, OK · Rural Health Clinic/Center in Oklahoma

Sources for this page

Verify at the official NPI Registry.