NPIMap

Organization Active NPI

Central Oklahoma Family Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ada, OK
National Provider Identifier
1154704237
Registry record updated Aug 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC.
Practice address
1221 Arlington St
Suite B
Ada, OK 74820-4058
Phone
(580) 925-3286
Fax
(580) 925-9149
NPI assigned
Jul 7, 2015
Last updated
Aug 25, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2015

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

Authorized official

Name
Brenda Ware
Title
Ceo
Phone
(580) 925-3286

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1221 Arlington St
Suite B
Ada, OK 74820-4058

Mailing address

527 W 3Rd St
Konawa, OK 74849-1415
Phone (580) 925-3286

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040722001013 OK Part B Supplier - Clinic/Group Practice 9931189685 Receives reassigned benefits from 68 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Seminole, OK; Stratford,, OK; Konawa, OK; Ada, OK
O20150914001483 OK Part A Provider - Federally Qualified Health Center (FQHC) 9931189685 Practice locations: Ada, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154704237. Details of each certification follow.

Federally qualified health center certification: CCN 371903

Legal name
CENTRAL OKLAHOMA FAMILY MEDICAL CENTER INC
Doing business as
CENTRAL OKLAHOMA FAMILY MEDICAL CENTER - ADA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 10, 2015
Last certification
Sep 10, 2015
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Oct 21, 1999 in OK
Enrollment address
1221 Arlington Street
Suite B
Ada, OK 74820-4067

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Marie Prewett Individual Corporate DirectorBoard Member Jul 9, 2015
Brenda Ware Individual Corporate DirectorCeo Jan 15, 2012 100%
W-2 Managing EmployeeCeo Jan 15, 2012 100%
Ramona Bunch Individual Corporate DirectorBoard Member Jul 9, 2015
Barry Streetman Individual Corporate DirectorBoard Member Jul 9, 2015
Billy Potts Individual Corporate DirectorBoard Member Jul 9, 2015
Susan Coleman Individual Corporate OfficerBoard Member Jan 25, 2016
Arthur Johnson Individual Corporate DirectorBoard Member Jul 9, 2015

All facility ownership & control disclosures 10

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

FacilityTypeRoleSince
Central Oklahoma Family Medical Center IncAda, OK, CCN 371936 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 1986
Central Oklahoma Family Medical Center IncStratford, OK, CCN 371948 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2019
Central Oklahoma Family Medical Center IncAda, OK, CCN 371965 Federally qualified health center Operational/Managerial Control (100%) Mar 25, 2002
Central Oklahoma Family Medical Center IncAda, OK, CCN 371969 Federally qualified health center Operational/Managerial Control Sep 1, 2021
Central Oklahoma Family Medical Center IncAda, OK, CCN 371972 Federally qualified health center Operational/Managerial Control Sep 1, 2021
Central Oklahoma Family Medical Center IncAda, OK, CCN 371976 Federally qualified health center Operational/Managerial Control Jan 11, 2022
Central Oklahoma Family Medical Center IncSeminole, OK, CCN 371977 Federally qualified health center Operational/Managerial Control May 3, 2022
Central Oklahoma Family Medical Center IncAda, OK, CCN 371978 Federally qualified health center Operational/Managerial Control Jun 1, 2022
Central Oklahoma Family Medical Center IncAda, OK, CCN 371979 Federally qualified health center Operational/Managerial Control Feb 1, 2022
Central Oklahoma Family Medical Center IncSeminole, OK, CCN 371005 Federally qualified health center Operational/Managerial Control (100%) Mar 25, 2002

Owned or controlled facilities with NPI records 10

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

Practitioners & affiliated clinicians

Practitioners 6

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": "1436227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440460800000",
    "number": "1154704237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 W 3RD ST",
            "city": "KONAWA",
            "state": "OK",
            "postal_code": "748491415",
            "telephone_number": "580-925-3286",
            "fax_number": "580-925-9149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 ARLINGTON ST",
            "address_2": "SUITE B",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748204058",
            "telephone_number": "580-925-3286",
            "fax_number": "580-925-9149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-07",
        "last_updated": "2015-08-25",
        "status": "A",
        "authorized_official_last_name": "WARE",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-925-3286"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ada, OK

Sources for this page

Verify at the official NPI Registry.