Urgent Care of Grand Lake PLLC

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

Legal business name

URGENT CARE OF GRAND LAKE PLLC

Practice address

900 S Main St
Grove, OK 74344-2844

Phone

(918) 232-6932

NPI assigned

Mar 13, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Chad Alan Perkins, PA-CNPI 1861662744

Title

Owner/Ceo

Phone

(918) 552-5546

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chad A Perkins, PA-C

  • Medical Physician Assistant
  • Grove, OK
  • NPI 1861662744
  Medicare reassignment Care Compare group Authorized official
• Rachel Ireton, PA-C

  • Physician Assistant
  • Tulsa, OK
  • NPI 1023524766
  Medicare reassignment Care Compare group
• Daniel Lee Nicoll, DO

  • Family Medicine Physician
  • Grove, OK
  • NPI 1487625505
  Medicare reassignment NPD
• Steven L. Nussbaum, D.O.

  • General Practice Physician
  • Tulsa, OK
  • NPI 1013987288
  Medicare reassignment NPD
• Kelsey Leigh Thompson, CNP

  • Family Nurse Practitioner
  • Tulsa, OK
  • NPI 1831654672
  Medicare reassignment NPD

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

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1154022689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 S MAIN ST",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "743442844",
            "telephone_number": "918-552-5546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 S MAIN ST",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "743442844",
            "telephone_number": "918-232-6932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URGENT CARE OF GRAND LAKE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "PERKINS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "918-552-5546",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyson Richard Trimble, D.O.
• TTD Management Trust
• Charles A Tullis, CFA
• Alison C Tuttle, PA-C
• Marcia D. Tynon, L.D.
• Raegan Vaughan, DDS
• Sara Margaret Vaughan, PA-C
• Vital Health Alliance Group
• Terri L Wadley, DPH
• Lindsey Waggoner

• Urgent Care Clinic/Center in Grove, OK
• Providers in Grove, OK by specialty
• Urgent Care Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.