Central Oklahoma Family Medical Center, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Ada, OK
NPI 1063988673 · NPPES record last updated Oct 22, 2018
Key facts
- NPI
- 1063988673
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 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
- Organization subpart
- No
Authorized official
- Name
- Brenda Ware
- Title
- Ceo
- Phone
- (580) 925-3286
Owners & managing parties with NPI records 14
Owned or controlled facilities with NPI records 9
Other NPIs on the same Medicare enrollment 15
Other NPIs with the same Medicare PAC ID 14
Facilities with the same owner 9
Practitioners 57
-
Jody Wayne Ardrey, ARNP-CNP
-
Amanda Lawhorn, LCSW
-
Erron Cody Proctor, PAC
-
Whitney Alyse Robertson, APRN
-
Erica R. Sun, D.O.
-
Melissa Lynn Adams, D.P.M
-
Lynn Dean Baggett, M.D.
-
Gayla Beth Branscum, LMHP
-
Justin Burnett, MD
-
Penni Cartlidge, APRN-CNP
-
Charlysa Diana Gatlin Castillo, APRN CNP
-
Semira Charboneau, D.O.
-
Lindsey Sue Conner, APRN
-
Michel Danette Cosby, APRN
-
Amanda Lynn Cubit, NP-C
-
Emily Nicole Davis, APRN-CNP
-
Kyndel Dillard, PA-C
-
Laura Lindsey Dooley, ARNP
-
John Keith Falsarella, M.D.
-
Robyn D Freeland, PA C
-
Jenna Geohagan, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in OK
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
- Corporation · Non-profit
- Incorporated
- May 11, 1966 in OK
- Enrollment address
- 905 Colony Drive BLDG
Ada, OK 74820-2297
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Carla Presley |
Other |
Sep 25, 2017 | |
| Marie Prewett |
Other |
Jul 9, 2015 | |
| Nancy Wilson |
Other |
Aug 24, 2017 | |
| Meagan Brooking |
Other |
Aug 24, 2017 | |
| Brenda Ware |
Corporate Director |
Jan 1, 2012 | 100% |
| W-2 Managing Employee |
Jan 1, 2012 | 100% | |
| Ramona Bunch |
Other |
Jul 9, 2015 | |
| Barry Streetman |
Other |
Jul 9, 2015 | |
| Billy Potts |
Other |
Jul 9, 2015 | |
| Judy Cantrell |
Other |
Oct 22, 2018 | |
| Susan Coleman |
Other |
Jan 25, 2016 | |
| Arthur Johnson |
Other |
Jul 9, 2015 | |
| Yvette McDonald |
Other |
Nov 23, 2015 | |
| Central Oklahoma Family Medical Center Inc |
Operational/Managerial Control | Jul 1, 1986 | 100% |
All facility ownership & control disclosures 9
| Facility | Type | Role | Since |
|---|---|---|---|
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 1, 2019 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Mar 25, 2002 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | Sep 1, 2021 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | Sep 1, 2021 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | Jan 11, 2022 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | May 3, 2022 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | Jun 1, 2022 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | Feb 1, 2022 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Mar 25, 2002 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
1121 Colony Dr
Ada, OK 74820
2901 Arlington St
Ada, OK 74820
Phone (580) 332-8900
325 N Monte Vista St
Ada, OK 74820
Phone (580) 272-0025
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
Other providers in Ada, OK
- Central Oklahoma Family Medical Center Inc
- Central Oklahoma Family Medical Center Inc
- Central Oklahoma Family Medical Center Inc
- Central Oklahoma Family Medical Center Inc
- Central Oklahoma Family Medical Center, Inc
- Central Oklahoma Family Medical Center, Inc
- Central Oklahoma Family Medical Center, Inc
- Central Oklahoma Family Medical Center, Inc.
- Central Oklahoma Family Medical Center, Inc.
- Central Oklahoma Family Medical Center, Inc.
All providers in Ada, OK · Federally Qualified Health Center (FQHC) in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.