NPIMap

Organization Active NPI

Arkansas Verdigris Valley Health Centers, Inc.

  • Family Medicine Physician
  • Porter, OK
National Provider Identifier
1083740047
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ARKANSAS VERDIGRIS VALLEY HEALTH CENTERS, INC.
Practice address
505 S Main
Porter, OK 74454
Phone
(918) 483-0111
Fax
(918) 483-0112
NPI assigned
Feb 26, 2007
Last updated
Apr 21, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

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

Authorized official

Name
Sonya L Smith
Title
Ceo
Phone
(918) 483-0111

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU
Dentist 122300000X NU
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

505 S Main
Porter, OK 74454

Mailing address

PO Box 334
Porter, OK 74454-0334
Phone (918) 483-0213

Other identifiers 1

IdentifierTypeStateIssuer
200109570AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070822000520 OK Part B Supplier - Clinic/Group Practice 2961594916 Receives reassigned benefits from 12 practitioners
3 other NPIs on this enrollment
Practice locations: Coweta, OK; Muskogee, OK; Porter, OK
O20090408000484 OK Part A Provider - Federally Qualified Health Center (FQHC) 2961594916 Practice locations: Porter, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083740047. Details of each certification follow.

Federally qualified health center certification: CCN 371853

Legal name
ARKANSAS VERDIGRIS VALLEY HEALTH CENTERS, INC.
Doing business as
PORTER HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 10, 2009
Last certification
Jul 10, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 9, 2005 in OK
Enrollment address
505 S Main
Porter, OK 74454-5864

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 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D1066304Arkansas Verdigris Valley Health Centers, Inc505 S Main, Porter, OK 74454Certificate of waiverMar 20, 2027

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/13866/brand/1/csg/1/fhir/r4

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
Wade Rousselot Individual Corporate OfficerSecretary Jan 1, 2020
Sonya Smith Individual W-2 Managing EmployeeCeo Jul 1, 2016 100%
Operational/Managerial ControlCeo Jul 1, 2016 100%
Benjamin T Harmon Individual Corporate DirectorBoard Member Nov 21, 2005
Yolanda K Harmon Individual Corporate OfficerVice President Jan 1, 2020
Chad E Marshall Individual Corporate DirectorBoard Member May 28, 2013
Elizabeth a Acree Individual Corporate Director Jan 1, 2020
Lewis a Parnell Individual Corporate OfficerBoard President Jan 1, 2020
Martha Diaz Deleon Individual Corporate DirectorBoard Member Jan 30, 2018
Shirley M Herring Individual Corporate OfficerBoard Treasurer Jan 25, 2011

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776729600000",
    "number": "1083740047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 334",
            "city": "PORTER",
            "state": "OK",
            "postal_code": "744540334",
            "telephone_number": "918-483-0213",
            "fax_number": "918-483-4174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 S MAIN",
            "city": "PORTER",
            "state": "OK",
            "postal_code": "74454",
            "telephone_number": "918-483-0111",
            "fax_number": "918-483-0112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARKANSAS VERDIGRIS VALLEY HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "SONYA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-483-0111"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200109570A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Porter, OK

Sources for this page

Verify at the official NPI Registry.