NPIMap

Organization Active NPI

Lake Health and Chiropractic, PLLC

  • Chiropractor
  • Grove, OK
National Provider Identifier
1073814596
Registry record updated Aug 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3930 Issued in OK
Legal business name
LAKE HEALTH AND CHIROPRACTIC, PLLC
Practice address
1107 E. 13TH St., Suites a&B
Grove, OK 74344-7956
Phone
(918) 786-8834
Fax
(918) 786-6520
NPI assigned
Nov 15, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2020

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

Authorized official

Name
Dr. Sammie Jo Ferguson, D.C.NPI 1265667836
Title
Manager/Co-Owner
Phone
(918) 786-8834

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3930 OK Primary

Addresses

Primary practice location

1107 E. 13TH St., Suites a&B
Grove, OK 74344-7956

Mailing address

1107 E. 13TH St., Suites a&B
Grove, OK 74344-7956
Phone (918) 786-8834

Other names 1

  • Stout-Ferguson Chiropractic Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110401000227 OK Part B Supplier - Clinic/Group Practice 1052594843 Receives reassigned benefits from 4 practitioners
Practice locations: Grove, OK

National Provider Directory

National Provider Directory
Tax ID family
Joe M Ferguson Dba Stout Clinic of Chiropractic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1107 E 13th St
Ste A
Grove, OK 74344
Phone (918) 786-8834

1107 E 13th St
Ste Ab
Grove, OK 74344
Phone (918) 786-8834

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1289779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596499200000",
    "number": "1073814596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 E. 13TH ST., SUITES A&B",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "743447956",
            "telephone_number": "918-786-8834",
            "fax_number": "918-786-6520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 E. 13TH ST., SUITES A&B",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "743447956",
            "telephone_number": "918-786-8834",
            "fax_number": "918-786-6520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HEALTH AND CHIROPRACTIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-15",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "SAMMIE",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "MANAGER/CO-OWNER",
        "authorized_official_telephone_number": "918-786-8834",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "3930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stout-Ferguson Chiropractic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Grove, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.