NPIMap

Organization Active NPI

Medrite Health LLC

  • Family Medicine Physician
  • Haskell, OK
National Provider Identifier
1144704107
Registry record updated Sep 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEDRITE HEALTH LLC
Practice address
102 N Broadway Ave
Haskell, OK 74436-9654
Phone
(918) 238-1700
NPI assigned
Sep 17, 2018
Last updated
Sep 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2018

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

Authorized official

Name
Benjamin BradleyNPI 1730518788
Title
Ceo
Phone
(918) 756-3114

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
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

102 N Broadway Ave
Haskell, OK 74436-9654

Mailing address

109 W 6TH St
Okmulgee, OK 74447-5015
Phone (918) 756-3114

Other practice location 1

109 W 6th St
Okmulgee, OK 74447-5015
Phone (918) 756-3114

Other identifiers 1

IdentifierTypeStateIssuer
200740340AMedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171214001215 OK Part B Supplier - Clinic/Group Practice 9436417748 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Okmulgee, OK

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1537142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537142400000",
    "number": "1144704107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 W 6TH ST",
            "city": "OKMULGEE",
            "state": "OK",
            "postal_code": "744475015",
            "telephone_number": "918-756-3114",
            "fax_number": "918-758-1358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 N BROADWAY AVE",
            "city": "HASKELL",
            "state": "OK",
            "postal_code": "744369654",
            "telephone_number": "918-238-1700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "109 W 6th St",
            "address_purpose": "LOCATION",
            "city": "Okmulgee",
            "state": "OK",
            "postal_code": "744475015",
            "country_code": "US",
            "telephone_number": "918-756-3114",
            "fax_number": "918-758-1358",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MEDRITE HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-17",
        "last_updated": "2018-09-17",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-756-3114"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200740340A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Haskell, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2018; 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.