NPIMap

Organization Active NPI

Mangum City Hospital Authority

Doing business as Mangum Regional Medical Center

  • Critical Access Hospital
  • Mangum, OK
National Provider Identifier
1033635263
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
MANGUM CITY HOSPITAL AUTHORITY
Doing business as
Mangum Regional Medical Center
Practice address
1 Wickersham St
Mangum, OK 73554-9117
Phone
(580) 782-3353
NPI assigned
Aug 18, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Andrea Snider
Title
Controller
Phone
(580) 782-3353

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X OK Primary

Addresses

Primary practice location

1 Wickersham St
Mangum, OK 73554-9117

Mailing address

PO Box 280
Mangum, OK 73554-0280
Phone (580) 782-3353

Other names 1

  • Mangum Regional Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20170905000055 OK Part A Provider - Critical Access Hospital 6305119942 Receives reassigned benefits from 15 practitioners
Practice locations: Mangum, OK
O20180228000171 OK Part A Provider - Critical Access Hospital 6305119942 Receives reassigned benefits from 1 practitioner
Practice locations: Mangum, OK
O20181020000126 OK Part B Supplier - Clinic/Group Practice 6305119942 Receives reassigned benefits from 39 practitioners
Practice locations: Mangum, OK

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1033635263. Details of each certification follow.

Hospital certification: CCN 371330

Legal name
MANGUM CITY HOSPITAL AUTHORITY
Doing business as
MANGUM REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Apr 1, 2005
Last certification
Nov 11, 2021
Beds
18
Ownership / control type
Hospital district or authority
Most recent change of ownership
Oct 1, 2005 (1 total)
Organization structure
OtherNon-profit
Enrollment address
1 Wickersham St
Mangum, OK 73554-9117
Other Hospital Practice Location

Hospital certification: CCN 37Z330

Legal name
MANGUM CITY HOSPITAL AUTHORITY
Doing business as
MANGUM REGIONAL MEDICAL CENTER
Organization structure
OtherNon-profit
Enrollment address
1 Wickersham St
Mangum, OK 73554-9117
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mangum Regional Medical CenterCCN 371330 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Kelley Martinez Individual Operational/Managerial ControlCeo Jun 1, 2023
Mangum City Hospital Authority Organization, Mangum, OK 5% Or Greater Direct Ownership Interest Jul 1, 1997 100%
Operational/Managerial Control Jul 1, 1997 100%
Cohesive Healthcare Management and Consulting LLC Organization, Shawnee, OK LLC, Management services company Operational/Managerial Control Mar 1, 2021
Danielle Cooper Individual W-2 Managing EmployeeBusiness Office Lead Jan 1, 2023

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Mangum City Hospital AuthorityMangum, OK, CCN 378541 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 22, 2019

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 40

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.

View all 40

Affiliated clinicians 12

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

NPI Registry JSON

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

{
    "created_epoch": "1503014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1033635263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280",
            "city": "MANGUM",
            "state": "OK",
            "postal_code": "735540280",
            "telephone_number": "580-782-3353",
            "fax_number": "580-782-5944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WICKERSHAM ST",
            "city": "MANGUM",
            "state": "OK",
            "postal_code": "735549117",
            "telephone_number": "580-782-3353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANGUM CITY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-18",
        "last_updated": "2022-07-21",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "SNIDER",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "580-782-3353"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mangum Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mangum, OK

Sources for this page

Verify at the official NPI Registry.