NPIMap

Organization Active NPI

Wellspring Family Clinic

  • Clinic/Center
  • Broken Arrow, OK
National Provider Identifier
1033526611
Registry record updated Jul 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
R0075262 Issued in OK
Legal business name
WELLSPRING FAMILY CLINIC
Practice address
1081 N. Birch Ave
Broken Arrow, OK 74012-0000
Phone
(918) 461-0422
Fax
(918) 461-0428
NPI assigned
Jul 16, 2014
Last updated
Jul 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2023

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

Authorized official

Name
Mrs. Kristi Gene Sager, APRN-CNPNPI 1033182258
Title
Nurse Practitioner/Owner
Phone
(918) 693-0834

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X R0075262 OK Primary

Addresses

Primary practice location

1081 N. Birch Ave
Broken Arrow, OK 74012-0000

Mailing address

1081 N. Birch Ave
Broken Arrow, OK 74012
Phone (918) 693-0834

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141105002038 OK Part B Supplier - Clinic/Group Practice 9638391782 Receives reassigned benefits from 3 practitioners
Practice locations: Broken Arrow, OK

National Provider Directory

National Provider Directory
Tax ID family
Wellspring Family Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1405468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690156800000",
    "number": "1033526611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1081 N. BIRCH AVE",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "74012",
            "telephone_number": "918-693-0834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1081 N. BIRCH AVE",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740120000",
            "telephone_number": "918-461-0422",
            "fax_number": "918-461-0428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPRING FAMILY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-16",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-21",
        "status": "A",
        "authorized_official_last_name": "SAGER",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "GENE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER/OWNER",
        "authorized_official_telephone_number": "918-693-0834",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN-CNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OK",
            "license": "R0075262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.