NPIMap

Organization Active NPI

Brookhaven Hospital, LLC

  • Psychiatric Hospital
  • Tulsa, OK
National Provider Identifier
1023064300
Registry record updated Sep 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
2313 Issued in OK
Legal business name
BROOKHAVEN HOSPITAL, LLC
Practice address
201 S Garnett Rd
Tulsa, OK 74128
Phone
(918) 438-4257
Fax
(918) 438-0083
NPI assigned
May 26, 2006
Last updated
Sep 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenneth Noel Pierce
Title
Cfo
Phone
(918) 438-4257

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 2313 OK
Psychiatric Hospital 283Q00000X 2313 OK Primary

Addresses

Primary practice location

201 S Garnett Rd
Tulsa, OK 74128

Mailing address

201 S Garnett Rd
Tulsa, OK 74128-1805
Phone (918) 438-4257

Other identifiers 12

IdentifierTypeStateIssuer
0901223MedicaidIA
100299900BMedicaidKS
100701410AMedicaidOK
1023064300MedicaidNC
Q029771MedicaidTN
160837125MedicaidAR
100701410BMedicaidOK
0157430MedicaidSD
10026694200MedicaidNE
100701410CMedicaidOK
1023064300MedicaidWA
00401269MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070620000421 OK Part B Supplier - Clinic/Group Practice 9739288580 Receives reassigned benefits from 1 practitioner
Practice locations: Tulsa, OK
O20090812000890 OK Part A Provider - Hospital 9739288580 Practice locations: Tulsa, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023064300. Details of each certification follow.

Hospital certification: CCN 374012

Legal name
BROOKHAVEN HOSPITAL LLC
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 8, 1986
Last certification
Nov 16, 2023
Beds
64
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Dec 5, 1985 in OK
Enrollment address
201 S Garnett Rd
Tulsa, OK 74128-1805
Main/Primary Hospital Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Brookhaven Hospital, LLCCCN 374012 · All quality measures
Type
Psychiatric
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Brookhaven Hospital Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

201 S Garnett Rd
Tulsa, OK 74128
Phone (918) 438-0083

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Stephen Chesney Individual 5% Or Greater Indirect Ownership Interest May 28, 2021 17.5%
Corporate OfficerBoard of Directors Vice Presiden May 28, 2021 17.5%
Craig Puno Individual Corporate OfficerBoard of Directors Treasurer May 28, 2021
Aaron Kneas Individual 5% Or Greater Indirect Ownership Interest May 28, 2021 35%
Corporate OfficerBoard of Directors Chief Financi May 28, 2021 35%
Mark Schneider Individual 5% Or Greater Indirect Ownership Interest May 28, 2021 30%
Corporate OfficerBoard of Directors President & C May 28, 2021 30%
Kenneth Pierce Individual W-2 Managing EmployeeChief Financial Officer Jan 1, 2019
Thomas Brown Individual Corporate OfficerCeo and Board Member Jan 1, 2019
W-2 Managing EmployeeCeo and Board Member Jan 1, 2019
Coby Nirider Individual W-2 Managing EmployeeAdministrator Jan 1, 2019
Ann Miller Individual 5% Or Greater Indirect Ownership Interest May 28, 2021 17.5%
Vizion Health - Brookhaven, LLC Organization, Charlotte, NC LLC 5% Or Greater Direct Ownership Interest May 28, 2021 100%

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631491200000",
    "number": "1023064300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S GARNETT RD",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741281805",
            "telephone_number": "918-438-4257",
            "fax_number": "918-438-0083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S GARNETT RD",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74128",
            "telephone_number": "918-438-4257",
            "fax_number": "918-438-0083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKHAVEN HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A",
        "authorized_official_last_name": "PIERCE",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "NOEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "918-438-4257"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "OK",
            "license": "2313",
            "primary": false
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "OK",
            "license": "2313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0901223",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100299900B",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100701410A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023064300",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q029771",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160837125",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100701410B",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0157430",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026694200",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100701410C",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023064300",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00401269",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.