NPIMap

Organization Active NPI

Grady Memorial Hospital

Doing business as Five Oaks Family Medical Clinic

  • Rural Health Clinic/Center
  • Chickasha, OK
National Provider Identifier
1164859260
Registry record updated Apr 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GRADY MEMORIAL HOSPITAL
Doing business as
Five Oaks Family Medical Clinic
Practice address
2100 W Iowa Ave
Suite a
Chickasha, OK 73018-2736
Phone
(405) 224-2100
Fax
(405) 779-2346
NPI assigned
Oct 3, 2013
Last updated
Apr 29, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2026

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

Authorized official

Name
Steve Pautler
Title
Ceo
Phone
(405) 779-2150

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X OK Primary

Addresses

Primary practice location

2100 W Iowa Ave
Suite a
Chickasha, OK 73018-2736

Mailing address

2100 W Iowa Ave Ste a
Chickasha, OK 73018-2736
Phone (405) 224-2100

Other identifiers 1

IdentifierTypeStateIssuer
100700820 KMedicaidOK

Other names 1

  • Five Oaks Family Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140317001560 OK Part A Provider - Rural Health Clinic 0648175778 Practice locations: Chickasha, OK
O20150520000323 OK Part B Supplier - Clinic/Group Practice 0648175778 Receives reassigned benefits from 26 practitioners
Practice locations: Chickasha, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164859260. Details of each certification follow.

Rural health clinic certification: CCN 373478

Legal name
GRADY MEMORIAL HOSPITAL
Doing business as
FIVE OAKS FAMILY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 17, 2014
Last certification
Nov 13, 2023
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Oct 12, 1982 in OK
Enrollment address
2100 W Iowa Avenue Suite a
Five Oaks Family Medical Clinic
Chickasha, OK 73018-2736
Related CCNs
370054

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

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

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
Grady Memorial Hospital Organization, Chickasha, OK Operational/Managerial Control Jan 1, 2014 100%
Donald Ferguson Individual Corporate DirectorBoard Member Aug 1, 1979
Jackie L McAdoo Individual Corporate OfficerVP of Finance Jan 1, 2016
W-2 Managing Employee Jan 1, 2016
Denver Talley Individual Corporate DirectorBoard Member Feb 1, 1997
Warren Spellman Individual Corporate OfficerChief Executive Officer May 28, 2013
James Earl Milton Individual Corporate DirectorBoard Member Nov 1, 2012
Chris Angel Individual Corporate DirectorBoard Member Feb 1, 2005

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Tuttle Family Medical ClinicTuttle, OK, CCN 378546 Rural health clinic Operational/Managerial Control Sep 1, 2021

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 29

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.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1380758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777420800000",
    "number": "1164859260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 W IOWA AVE STE A",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730182736",
            "telephone_number": "405-224-2100",
            "fax_number": "405-779-2346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 W IOWA AVE",
            "address_2": "SUITE A",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730182736",
            "telephone_number": "405-224-2100",
            "fax_number": "405-779-2346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRADY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-03",
        "last_updated": "2026-04-29",
        "certification_date": "2026-04-29",
        "status": "A",
        "authorized_official_last_name": "PAUTLER",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-779-2150"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100700820 K",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Five Oaks Family Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chickasha, OK

Sources for this page

Verify at the official NPI Registry.