NPIMap

Organization Active NPI

Central Oklahoma Family Medical Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Ada, OK
National Provider Identifier
1063988673
Registry record updated Oct 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC
Practice address
905 Colony Drive BLDG
Ada, OK 74820
Phone
(580) 925-3286
NPI assigned
Oct 22, 2018
Last updated
Oct 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2018

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

Authorized official

Name
Brenda Ware
Title
Ceo
Phone
(580) 925-3286

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

905 Colony Drive BLDG
Ada, OK 74820

Mailing address

527 W 3Rd St
Konawa, OK 74849-1415
Phone (580) 925-3286

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040722001013 OK Part B Supplier - Clinic/Group Practice 9931189685 Receives reassigned benefits from 68 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Seminole, OK; Stratford,, OK; Konawa, OK; Ada, OK
O20190228002696 OK Part A Provider - Federally Qualified Health Center (FQHC) 9931189685 Practice locations: Ada, OK
O20210715003550 OK DME Supplier - Physician - Podiatry 9931189685 Practice locations: Ada, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063988673. Details of each certification follow.

Federally qualified health center certification: CCN 371936

Legal name
CENTRAL OKLAHOMA FAMILY MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 16, 2019
Last certification
Jan 16, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 11, 1966 in OK
Enrollment address
905 Colony Drive BLDG
Ada, OK 74820-2297

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Carla Presley Individual OtherBoard Member Sep 25, 2017
Marie Prewett Individual OtherBoard President Jul 9, 2015
Nancy Wilson Individual OtherBoard Member Aug 24, 2017
Meagan Brooking Individual OtherBoard Member Aug 24, 2017
Brenda Ware Individual Corporate DirectorCeo Jan 1, 2012 100%
W-2 Managing EmployeeCeo Jan 1, 2012 100%
Ramona Bunch Individual OtherBoard Member Jul 9, 2015
Barry Streetman Individual OtherTreasurer of Board Jul 9, 2015
Billy Potts Individual OtherBoard Member Jul 9, 2015
Judy Cantrell Individual OtherBoard Member Oct 22, 2018
Susan Coleman Individual OtherBoard Vice-President Jan 25, 2016
Arthur Johnson Individual OtherBoard Member Jul 9, 2015
Yvette McDonald Individual OtherBoard Secretary Nov 23, 2015
Central Oklahoma Family Medical Center Inc Organization, Konawa, OK Corporation, Non-profit Operational/Managerial Control Jul 1, 1986 100%

Owners & managing parties with NPI records 14

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

View all 14

All facility ownership & control disclosures 9

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

FacilityTypeRoleSince
Central Oklahoma Family Medical Center IncStratford, OK, CCN 371948 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2019
Central Oklahoma Family Medical Center IncAda, OK, CCN 371965 Federally qualified health center Operational/Managerial Control (100%) Mar 25, 2002
Central Oklahoma Family Medical Center IncAda, OK, CCN 371969 Federally qualified health center Operational/Managerial Control Sep 1, 2021
Central Oklahoma Family Medical Center IncAda, OK, CCN 371972 Federally qualified health center Operational/Managerial Control Sep 1, 2021
Central Oklahoma Family Medical Center IncAda, OK, CCN 371976 Federally qualified health center Operational/Managerial Control Jan 11, 2022
Central Oklahoma Family Medical Center IncSeminole, OK, CCN 371977 Federally qualified health center Operational/Managerial Control May 3, 2022
Central Oklahoma Family Medical Center IncAda, OK, CCN 371978 Federally qualified health center Operational/Managerial Control Jun 1, 2022
Central Oklahoma Family Medical Center IncAda, OK, CCN 371979 Federally qualified health center Operational/Managerial Control Feb 1, 2022
Central Oklahoma Family Medical Center IncSeminole, OK, CCN 371005 Federally qualified health center Operational/Managerial Control (100%) Mar 25, 2002

Owned or controlled facilities with NPI records 9

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

Facilities with the same owner 9

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1540166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540166400000",
    "number": "1063988673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 W 3RD ST",
            "city": "KONAWA",
            "state": "OK",
            "postal_code": "748491415",
            "telephone_number": "580-925-3286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 COLONY DRIVE BLDG",
            "city": "ADA",
            "state": "OK",
            "postal_code": "74820",
            "telephone_number": "580-925-3286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-22",
        "last_updated": "2018-10-22",
        "status": "A",
        "authorized_official_last_name": "WARE",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-925-3286"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ada, OK

Sources for this page

Verify at the official NPI Registry.