Integris Bass Baptist Health Center
Organization Active NPI Family Medicine Physician · Waynoka, OK
NPI 1124029293 · NPPES record last updated Apr 7, 2025
Key facts
- NPI
- 1124029293
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- INTEGRIS BASS BAPTIST HEALTH CENTER
- Practice address
- 1084 Nickerson St
Waynoka, OK 73860-1245 - Phone
- (580) 824-2281
- NPI assigned
- Aug 10, 2005
- Organization subpart
- No
Authorized official
- Name
- Donna Wallace
- Title
- Assistant Treasurer
- Phone
- (636) 359-4890
Owners & managing parties with NPI records 5
-
Best Chen, DO
-
Justin Lee Funk, O.D.
Other NPIs on the same Medicare enrollment 17
Other NPIs with the same Medicare PAC ID 3
Facilities with the same owner 31
Practitioners 39
-
Laelani Baca, APRN
-
Jami Luann Benton, M.D.
-
Courtney Nicole Campbell, APRN
-
Neil Edward Crittenden, M.D.
-
George Hudson, DO
-
Michael D Landes, MD
-
Marie Marianne McCune, NP-C
-
Salman Nusrat, M.D.
-
Carl Andrew Raczkowski, M.D.
-
Zachary Daniel Smith, M.D.
-
Sumit A Walia, MD
-
Linda Sue Woodruff, ARNP
-
Rohtashav Dhir, M.D., M.P.H,
-
Arlyn Gail Wing, P.A.C.
-
Dustin Lee Baylor, M.D.
-
Steven Ross Mareburger, M.D.
-
Charles H Morgan, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OK
Rural health clinic certification: CCN 373872
- Legal name
- INTEGRIS BASS BAPTIST HEALTH CENTER
- Doing business as
- INTEGRIS HEALTH MEDICAL GROUP WAYNOKA
- Certification status
- Terminated Voluntary: merger or closure, Dec 1, 2025
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 1, 2003
- Last certification
- Oct 12, 2023
- Ownership / control type
- 2B
- Organization structure
- LLC · Non-profit
- Incorporated
- Feb 14, 1994 in OK
- Enrollment address
- 1084 Nickerson St
Waynoka, OK 73860-1245
All disclosed owners & managing parties 24
| Name | Role | Since | Share |
|---|---|---|---|
| Elizabeth Partridge |
Contracted Managing Employee |
Jul 1, 2024 | |
| Operational/Managerial Control |
Jul 1, 2024 | ||
| Christina Hopper |
Corporate Officer | Jul 1, 2024 | |
| Corporate Director | Jul 1, 2024 | ||
| Donna M Wallace |
Corporate Officer |
Oct 27, 2023 | |
| Mark a McCulley |
Corporate Director | Jul 1, 2020 | |
| Christopher a Shearer |
Corporate Director | Apr 20, 2005 | |
| Brian D Atwood |
Corporate Director | Jan 1, 2002 | |
| Michael S Jackson |
Corporate Officer | May 1, 2019 | |
| Elizabeth R Kinzie |
Contracted Managing Employee |
Aug 31, 2017 | |
| Operational/Managerial Control |
Aug 31, 2017 | ||
| Jason Turnbow |
Corporate Director | Jul 1, 2024 | |
| Michael L Weed |
Corporate Officer |
Jan 1, 2023 | |
| Justin L Funk |
Corporate Director | Jul 1, 2024 | |
| Megan J Darrow |
Corporate Director | Jul 1, 2021 | |
| Integris Health Inc |
Operational/Managerial Control | Jul 1, 1994 | |
| Brent Hubbard |
Corporate Officer | Jul 1, 2022 | |
| Corporate Director | Jul 1, 2022 | ||
| John R Bullis |
Corporate Officer | Jul 1, 2024 | |
| Corporate Director | Jul 1, 2021 | ||
| Baptist Healthcare of Oklahoma LLC |
Operational/Managerial Control | Jun 7, 1978 | |
| Brian Winter |
Corporate Director | Jul 1, 2024 | |
| Keaton Francis |
Contracted Managing Employee |
Jan 9, 2023 | |
| Corporate Officer |
Jan 9, 2023 | ||
| Operational/Managerial Control |
Jan 9, 2023 | ||
| Integris Rural Health Inc |
Operational/Managerial Control | Jul 1, 1994 | |
| Amber D Bellar |
Contracted Managing Employee |
Jul 1, 2024 | |
| Operational/Managerial Control |
Jul 1, 2024 | ||
| Jonathan C Bartley |
Corporate Officer | Jul 1, 2024 | |
| Corporate Director | Jul 1, 2020 | ||
| Aaron Harmon |
Corporate Director | Jul 1, 2024 | |
| Casey Felix |
Corporate Director | Jul 1, 2018 | |
| Best Chen |
Corporate Officer | Jul 1, 2024 | |
| Corporate Director | Jul 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030820000010 | OK | Part a Provider - Rural Health Clinic | 0345151981 | Practice locations: Waynoka, OK |
| O20031103000717 | OK | Part B Supplier - Clinic/Group Practice | 0345151981 |
Receives reassigned benefits from 28 practitioners 17 other NPIs on this enrollment Practice locations: Medford, OK; Hennessey, OK; Enid, OK |
National Provider Directory
Locations
3001 Quail Springs Pkwy
Fl 5
Oklahoma City, OK 73134
1084 Nickerson St
Waynoka, OK 73860
Phone (580) 824-2281
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Rural Health Clinic/Center | 261QR1300X |
Addresses
Primary practice location
1084 Nickerson St
Waynoka, OK 73860-1245
Mailing address
PO Box 200731
Dallas, TX 75320-0731
Phone (405) 252-8400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100699500K | Medicaid | OK | |
| 100755790C | Medicaid | OK |
Other names
- INTEGRIS HEALTH MEDICAL GROUP WAYNOKA
Other providers in Waynoka, OK
- Clarissa M Fifield
- Dian Linnea Frey
- Kristen Renea Harris
- Marissa Hofen
- Christy Jo Hood
- Jerrys Pharmacy
- Bobbie Jean Jones
- Elizabeth Romanik Kinzie
- Jeannie Long
- Jonilla Deane Long
All providers in Waynoka, OK · Family Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.