NPIMap

Organization Active NPI

Stillwater Medical Center Authority

Doing business as Blackwell Regional Hospital

  • Rural Acute Care Hospital
  • Blackwell, OK
National Provider Identifier
1104375237
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
Legal business name
STILLWATER MEDICAL CENTER AUTHORITY
Doing business as
Blackwell Regional Hospital
Stillwater Medical - Blackwell
Practice address
710 S 13TH St
Blackwell, OK 74631-3700
Phone
(580) 363-2311
NPI assigned
Sep 30, 2016
Last updated
Apr 1, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2025

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

Authorized official

Name
Courtney Kozikuski, CEO
Title
Cfo
Phone
(580) 363-2311

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X
Rural Acute Care Hospital 282NR1301X Primary

Addresses

Primary practice location

710 S 13TH St
Blackwell, OK 74631-3700

Mailing address

PO Box 720006
Norman, OK 73070-4006
Phone (405) 533-5300

Other names 2

  • Blackwell Regional Hospital Doing business as
  • Stillwater Medical - Blackwell Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230405000539 OK Part A Provider - Rural Emergency Hospital (Reh) 2365353794 Practice locations: Blackwell, OK

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1104375237. Details of each certification follow.

Hospital certification: CCN 370780

Legal name
STILLWATER MEDICAL CENTER AUTHORITY
Doing business as
STILLWATER MEDICAL - BLACKWELL
Certification status
Active
Provider type (POS)
Hospital – Rural emergency hospital
Participating since
Jul 1, 2023
Last certification
Jul 1, 2023
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Incorporated
Jan 3, 2006 in OK
Enrollment address
710 S 13TH St
Blackwell, OK 74631-3700
Main/Primary Hospital Location

Hospital certification: CCN 370030

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
STILLWATER MEDICAL-BLACKWELL
Certification status
Terminated Other: provider status change, Jun 30, 2023
Provider type (POS)
Hospital – Short-term
Participating since
Jan 1, 1975
Last certification
Oct 13, 2021
Beds
25
Ownership / control type
Hospital district or authority
Most recent change of ownership
Jan 1, 2020 (5 total)
Facility address
710 S 13TH Street
Blackwell, OK 74631

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

Other NPIs with the same Medicare PAC ID 10

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Stillwater Medical-BlackwellCCN 370780 · All quality measures
Type
Rural Emergency Hospital
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
37D0475561Stillwater Medical Center Blackwell710 South 13TH, Blackwell, OK 74631AccreditationMar 20, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Steven Taylor Individual Corporate OfficerCeo Jan 1, 2020
W-2 Managing Employee Jan 1, 2020
Stillwater Medical Center Authority Organization, Stillwater, OK 5% Or Greater Direct Ownership Interest Jan 1, 2020 100%
Courtney Kozikuski Individual Corporate OfficerCfo Jan 1, 2020
W-2 Managing Employee Jan 1, 2020

Owners & managing parties with NPI records 10

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

All facility ownership & control disclosures 8

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

FacilityTypeRoleSince
Stillwater Medical CenterStillwater, OK, CCN 370049 Hospital Operational/Managerial Control Oct 30, 2007
Stillwater Medical CenterStillwater, OK, CCN 37T049 Hospital Operational/Managerial Control Oct 30, 2007
Stillwater Medical PerryPerry, OK, CCN 370779 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018
Stillwater Medical at Home - Home HealthStillwater, OK, CCN 377204 Home health agency 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Oct 27, 1992
Oct 27, 1992
Stillwater Medical at HomeStillwater, OK, CCN 371500 Hospice 5% Or Greater Indirect Ownership Interest (100%) Jun 30, 2017
Community Medical ClinicPerry, OK, CCN 373495 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018
Perry Family PhysiciansPerry, OK, CCN 378531 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2018
Blackwell Primary CareBlackwell, OK, CCN 378545 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2018

Owned or controlled facilities with NPI records 8

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

Facilities with the same owner 8

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

Practitioners & affiliated clinicians

Practitioners 11

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 64

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1475193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743465600000",
    "number": "1104375237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 720006",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730704006",
            "telephone_number": "405-533-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 S 13TH ST",
            "city": "BLACKWELL",
            "state": "OK",
            "postal_code": "746313700",
            "telephone_number": "580-363-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILLWATER MEDICAL CENTER AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-30",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A",
        "authorized_official_last_name": "KOZIKUSKI",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "580-363-2311",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blackwell Regional Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stillwater Medical - Blackwell",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blackwell, OK

Sources for this page

Verify at the official NPI Registry.