Bristow Endeavor Healthcare, LLC

Primary specialty

Special HospitalTaxonomy code 284300000X

Legal business name

BRISTOW ENDEAVOR HEALTHCARE, LLC

Doing business as

Center for Orthopaedic Reconstruction and Excellence

Practice address

3029 W. Main Street
Jenks,, OK 74037

Phone

(918) 701-2300

Fax

(918) 417-7104

NPI assigned

Jan 18, 2018

Last updated

Nov 18, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

BRISTOW ENDEAVOR HEALTHCARE, LLCAs reported in NPPES

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

Authorized official

Name

Melinda Kay Whitaker

Title

Credentialing Coordinator

Phone

(918) 701-2313

Specialties & licenses 1

Addresses

Other names 1

• Center for Orthopaedic Reconstruction and Excellence Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114435666. Details of each certification follow.

• CCN 370041 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 370041

Legal name

CENTER FOR ORTHOPAEDIC RECONSTRUCTION AND EXCELLEN

Certification status

Terminated Voluntary: merger or closure, Sep 8, 2023

Provider type (POS)

Hospital – Short-term

Participating since

Jul 1, 1966

Last certification

Aug 1, 2019

Beds

49

Ownership / control type

Hospital district or authority

Most recent change of ownership

Mar 6, 2014 (6 total)

Facility address

3029 West Main Street
Jenks, OK 74037

Part of

Bristow Endeavor Healthcare

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IAJJBD

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Bristow Endeavor Healthcare, LLC

  dba Bristow Family Practice, Urgent Care

  • Family Medicine Physician
  • Bristow, OK
  • NPI 1265863583
  NPPES parent name

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

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668729600000",
    "number": "1114435666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1809 E 13TH ST STE 300",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044431",
            "telephone_number": "918-701-2302",
            "fax_number": "539-235-0028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3029 W. MAIN STREET",
            "city": "JENKS,",
            "state": "OK",
            "postal_code": "74037",
            "telephone_number": "918-701-2300",
            "fax_number": "918-417-7104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOW ENDEAVOR HEALTHCARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRISTOW ENDEAVOR HEALTHCARE, LLC",
        "enumeration_date": "2018-01-18",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A",
        "authorized_official_last_name": "WHITAKER",
        "authorized_official_first_name": "MELINDA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "918-701-2313"
    },
    "taxonomies": [
        {
            "code": "284300000X",
            "taxonomy_group": "",
            "desc": "Special Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Orthopaedic Reconstruction and Excellence",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Center for Orthopaedic Reconstruction and Excellence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gwendolyn Ann Boyd, OTR
• Donna C Bradley, RN, IBCLC
• Patrick Paul Branagan, D.P.M.
• Savannah Clay Brian
• Kimberly Lynn Briguccia, PT
• Bristow Endeavor Healthcare, LLC (CORE Pain & Wellness Center)
• Melissa Ann Broaddus, MSW
• Brookshire Grocery Company (Reasors Pharmacy)
• Amy Marie Brown, MHR, LPC
• Mackenzie Brubaker, CRNA

• Special Hospital in Jenks, OK
• Providers in Jenks, OK by specialty
• Special Hospital in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.