NPIMap

Organization Active NPI

Crossroads 1010 LLC

  • Community/Behavioral Health Agency
  • Antlers, OK
National Provider Identifier
1174072482
Registry record updated Nov 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CROSSROADS 1010 LLC
Practice address
193908 US Hwy 271
Antlers, OK 74523
Phone
(580) 271-7080
Fax
(580) 298-2081
NPI assigned
Sep 27, 2016
Last updated
Nov 27, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2018

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

Authorized official

Name
Jennifer Griffin, LPC
Title
Owner
Phone
(580) 317-7002

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

193908 US Hwy 271
Antlers, OK 74523

Mailing address

P.O. Bo 1012
Antlers, OK 74523
Phone (580) 271-7080

Other identifiers 1

IdentifierTypeStateIssuer
200734990AMedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240515002291 OK Part B Supplier - Clinic/Group Practice 5092156596 Receives reassigned benefits from 8 practitioners
Practice locations: Antlers, OK

National Provider Directory

National Provider Directory

Locations

193908 US Highway 271
Antlers, OK 74523
Phone (580) 271-7080

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1474934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543276800000",
    "number": "1174072482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BO 1012",
            "city": "ANTLERS",
            "state": "OK",
            "postal_code": "74523",
            "telephone_number": "580-271-7080",
            "fax_number": "580-298-2081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "193908 US HWY 271",
            "city": "ANTLERS",
            "state": "OK",
            "postal_code": "74523",
            "telephone_number": "580-271-7080",
            "fax_number": "580-298-2081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS 1010 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-27",
        "last_updated": "2018-11-27",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-317-7002",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200734990A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Antlers, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.