NPIMap

Organization Active NPI

Jane Phillips Memorial Medical Center, Inc

  • Rehabilitation Hospital Unit
  • Bartlesville, OK
National Provider Identifier
1053456111
Registry record updated May 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
2190 Issued in OK
Legal business name
JANE PHILLIPS MEMORIAL MEDICAL CENTER, INC
Practice address
3500 E Frank Phillips Blvd
Bartlesville, OK 74006-2411
Phone
(918) 333-7200
Fax
(918) 331-1447
NPI assigned
Feb 20, 2007
Last updated
May 22, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2008

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

Authorized official

Name
Mike A. Moore
Title
Cfo
Phone
(918) 331-1644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 2190 OK Primary

Addresses

Primary practice location

3500 E Frank Phillips Blvd
Bartlesville, OK 74006-2411

Mailing address

3500 E Frank Phillips Blvd
Bartlesville, OK 74006-2411
Phone (918) 333-7200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080520000553 OK Part A Provider - Hospital 0547170888 Practice locations: Bartlesville, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053456111. Details of each certification follow.

Hospital certification: CCN 37T018

Legal name
JANE PHILLIPS MEMORIAL MEDICAL CENTER INC
Organization structure
CorporationNon-profit
Incorporated
Feb 2, 1950 in OK
Enrollment address
3500 E Frank Phillips Blvd
Bartlesville, OK 74006-2411
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

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

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Jane Phillips Memorial Medical CenterCCN 37T018 · All quality measures
Ownership
Non-profit
Certified
Oct 1, 2005

National Provider Directory

National Provider Directory
Tax ID family
Jane Phillips Memorial3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

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
Jane Phillips Memorial Medical Center Inc Organization, Bartlesville, OK Non-profit Operational/Managerial Control Oct 1, 2007 100%
Tanner Holt Individual Corporate OfficerCeo Oct 1, 2025 10%
Brad Rector Individual Operational/Managerial ControlBoard Member Jul 1, 2020 10%
Bert Walthall Individual Operational/Managerial ControlBoard Member Jul 1, 2020 10%
Paul Atkisson Individual Operational/Managerial ControlBoard Member Jan 1, 2023 10%
Stephen Colaw Individual Operational/Managerial ControlBoard Member Jan 1, 2024 10%
Paul McQuillen Individual Operational/Managerial ControlBoard Member Jan 1, 2023 10%
Tammie Strobel Individual Operational/Managerial ControlBoard Member Jan 1, 2024 10%
Anderson Mehrle Individual Operational/Managerial ControlBoard Member Jan 1, 2024 10%

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Sedan City HospitalSedan, KS, CCN 171318 Hospital Operational/Managerial Control Apr 1, 2003
Sedan City HospitalSedan, KS, CCN 17Z318 Hospital Operational/Managerial Control Apr 1, 2003
Ascension Jane Phillips NowataNowata, OK, CCN 371305 Hospital 5% Or Greater Direct Ownership Interest Jul 1, 1999
Ascension Jane Phillips NowataNowata, OK, CCN 37Z305 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1999
Jane Phillips Memorial Medical Center IncBartlesville, OK, CCN 37U018 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 23, 1996

Owned or controlled facilities with NPI records 6

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

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211414400000",
    "number": "1053456111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 E FRANK PHILLIPS BLVD",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740062411",
            "telephone_number": "918-333-7200",
            "fax_number": "918-331-1447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 E FRANK PHILLIPS BLVD",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740062411",
            "telephone_number": "918-333-7200",
            "fax_number": "918-331-1447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JANE PHILLIPS MEMORIAL MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2008-05-22",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "918-331-1644"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "OK",
            "license": "2190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartlesville, OK

Sources for this page

Verify at the official NPI Registry.