NPIMap

Organization Active NPI

Cimarron Memorial Hospital and Nursing Home

Doing business as Cimarron Memorial Hospital

  • Critical Access Hospital
  • Boise City, OK
National Provider Identifier
1073584819
Registry record updated Jun 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
CIMARRON MEMORIAL HOSPITAL AND NURSING HOME
Doing business as
Cimarron Memorial Hospital
Practice address
100 S Ellis
Boise City, OK 73933-1059
Phone
(580) 544-2501
Fax
(580) 544-2517
NPI assigned
Jan 30, 2006
Last updated
Jun 29, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2023

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

Authorized official

Name
Jonathan W Gleason
Title
Ceo
Phone
(580) 589-0231

Specialties & licenses 1

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

Addresses

Primary practice location

100 S Ellis
Boise City, OK 73933-1059

Mailing address

PO Box 1059
Boise City, OK 73933-1059
Phone (580) 544-2501

Other identifiers 2

IdentifierTypeStateIssuer
000370146001OtherBCBS
100700740AMedicaidOK

Other names 1

  • Cimarron Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040715000425 OK Part A Provider - Critical Access Hospital 5698686517 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
Practice locations: Boise City, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073584819. Details of each certification follow.

Hospital certification: CCN 371307

Legal name
CIMARRON MEMORIAL HOSPITAL AND NURSING HOME
Doing business as
CIMARRON MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2000
Last certification
Sep 13, 2024
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
GovernmentNon-profit
Enrollment address
100 S Ellis
Cimarron Memorial Hospital
Boise City, OK 73933-1059
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Cimarron Memorial HospitalCCN 371307 · 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
Tax ID family
Cimarron Memorial Hosp3 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 4

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

NameRoleSinceShare
Jessica Puebla Individual W-2 Managing EmployeeRevenue Cycle MGR, Him Jun 23, 2024
Barbara Miller Individual Corporate OfficerCfo Jun 23, 2024 5%
Cimarron Memorial Hospital and Nursing Home Organization, Boise City, OK Operational/Managerial Control Jan 1, 2010
Clay Crabtree Individual Corporate DirectorBod - Chairman Mar 8, 2021

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 2

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

FacilityTypeRoleSince
Cimarron Memorial HospitalBoise City, OK, CCN 37Z307 Hospital Operational/Managerial Control Jan 1, 2010
Cimarron Memorial Rural Health ClinicBoise City, OK, CCN 373459 Rural health clinic Operational/Managerial Control Jan 1, 2010

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 7

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.

Affiliated clinicians 8

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": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687996800000",
    "number": "1073584819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1059",
            "city": "BOISE CITY",
            "state": "OK",
            "postal_code": "739331059",
            "telephone_number": "580-544-2501",
            "fax_number": "580-544-2517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S ELLIS",
            "city": "BOISE CITY",
            "state": "OK",
            "postal_code": "739331059",
            "telephone_number": "580-544-2501",
            "fax_number": "580-544-2517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIMARRON MEMORIAL HOSPITAL AND NURSING HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-30",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A",
        "authorized_official_last_name": "GLEASON",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-589-0231"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000370146001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100700740A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cimarron Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cimarron Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boise City, OK

Sources for this page

Verify at the official NPI Registry.