NPIMap

Organization Active NPI

St. John Physicians, Inc

  • Rural Health Clinic/Center
  • Barnsdall, OK
National Provider Identifier
1033176367
Registry record updated Sep 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ST. JOHN PHYSICIANS, INC
Practice address
112 North 5TH Street
Barnsdall, OK 74002-0609
Phone
(918) 847-2558
Fax
(918) 847-2053
NPI assigned
Apr 28, 2006
Organization subpart
No

Owners & managing parties with NPI records 3

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

Owned or controlled facilities with NPI records 3

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

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 3

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

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 894

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

View all 894

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031121000867 OK Part B Supplier - Clinic/Group Practice 2567366495 Receives reassigned benefits from 895 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tulsa, OK; Skiatook, OK; Sapulpa, OK; Pryor, OK; Owasso, OK; Grove, OK; Broken Arrow, OK; Bartlesville, OK…
O20151007001934 OK Part A Provider - Rural Health Clinic 2567366495 1 other NPI on this enrollment
Practice locations: Barnsdall, OK

Rural health clinic certification: CCN 373824

Legal name
ST. JOHN PHYSICIANS, INC.
Doing business as
ST JOHN CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 15, 1994
Last certification
Sep 28, 2020
Ownership / control type
1B
Most recent change of ownership
Jun 1, 2015 (1 total)
Organization structure
CorporationProprietary
Incorporated
Mar 23, 1987 in OK
Enrollment address
112 North 5TH Street
Barnsdall, OK 74002-6616

All disclosed owners & managing parties 4

Medicare enrollment files

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

NameRoleSinceShare
James Bryan Fissel Individual Corporate Officer Jan 1, 2012
St. John Physicians, Inc. Organization, Tulsa, OK Corporation, For-profit 5% Or Greater Direct Ownership Interest Jun 1, 2015 100%
Harpreet Jakhar Individual W-2 Managing Employee Aug 24, 2020
Thomas Hartman Individual W-2 Managing Employee May 18, 2022

All facility ownership & control disclosures 2

Medicare enrollment files

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

FacilityTypeRoleSince
Jane Phillips Coffeyville Rural Health ClinicCoffeyville, KS, CCN 178934 Rural health clinic Operational/Managerial Control (100%) Jun 30, 2014
SJC Caney Rural Health ClinicCaney, KS, CCN 173893 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 30, 2014

National Provider Directory

National Provider Directory

Locations

218 W 4th Ave
Ofc
Caney, KS 67333
Phone (620) 251-5000

218 W 4th Ave
Caney, KS 67333
Phone (620) 879-2182

1505 W 11th St
Ofc
Coffeyville, KS 67337
Phone (620) 251-5000

800 W Boise Cir
Ste 120
Broken Arrow, OK 74012
Phone (918) 944-9280

705 W Rogers Blvd
Skiatook, OK 74070
Phone (918) 396-2893

1919 S Wheeling Ave
Ste 204
Tulsa, OK 74104
Phone (918) 403-7200

1725 E 19th St
Ste 500
Tulsa, OK 74104
Phone (918) 403-7089

Dept 1376
Tulsa, OK 74182

1705 E 19th St
Ste 707
Tulsa, OK 74104
Phone (918) 748-8381

1919 S Wheeling Ave
Ste 504
Tulsa, OK 74104
Phone (918) 747-8071

1705 E 19th St
Ste 705
Tulsa, OK 74104
Phone (918) 744-7887

1725 E 19th St
Ste 600
Tulsa, OK 74104
Phone (918) 748-1330

2000 S Wheeling Ave
Ste 900
Tulsa, OK 74104
Phone (918) 403-6284

1919 S Wheeling Ave
Ste 710
Tulsa, OK 74104
Phone (918) 742-7331

NPPES NPI Registry

Updated by the provider on Sep 2, 2016

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

Authorized official

Name
Gayle Burden
Title
Director
Phone
(918) 331-1090

Specialties & licenses 1

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

Addresses

Primary practice location

112 North 5TH Street
Barnsdall, OK 74002-0609

Mailing address

112 N 5TH
P.O. Box 609
Barnsdall, OK 74002-0609
Phone (918) 847-2558

Other names 1

  • Siggins Memorial Clinic Doing business as

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472774400000",
    "number": "1033176367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 N 5TH",
            "address_2": "P.O. BOX 609",
            "city": "BARNSDALL",
            "state": "OK",
            "postal_code": "740020609",
            "telephone_number": "918-847-2558",
            "fax_number": "918-847-2053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 NORTH 5TH STREET",
            "city": "BARNSDALL",
            "state": "OK",
            "postal_code": "740020609",
            "telephone_number": "918-847-2558",
            "fax_number": "918-847-2053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN PHYSICIANS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-28",
        "last_updated": "2016-09-02",
        "status": "A",
        "authorized_official_last_name": "BURDEN",
        "authorized_official_first_name": "GAYLE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "918-331-1090"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Siggins Memorial Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Barnsdall, OK

Sources for this page

Verify at the official NPI Registry.