NPIMap

Organization Active NPI

Integris Miami Hospital

Doing business as Integris Home Care Northeast

  • Home Health Agency
  • Miami, OK
National Provider Identifier
1194748319
Registry record updated Aug 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
INTEGRIS MIAMI HOSPITAL
Doing business as
Integris Home Care Northeast
Practice address
207 2ND Ave SW
Miami, OK 74354-6818
Phone
(918) 540-2577
NPI assigned
Jul 26, 2006
Last updated
Aug 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2024

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

Authorized official

Name
Donna Wallace
Title
Assistant Treasurer
Phone
(636) 359-4890

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

207 2ND Ave SW
Miami, OK 74354-6818

Mailing address

PO Box 200759
Dallas, TX 75320-0759
Phone (405) 252-8319

Other identifiers 1

IdentifierTypeStateIssuer
100699440DMedicaidOK

Other names 1

  • Integris Home Care Northeast Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080527000640 OK Part A Provider - Home Health Agency 1254235468 1 other NPI on this enrollment
Practice locations: Miami, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194748319. Details of each certification follow.

Home health agency certification: CCN 377050

Legal name
INTEGRIS MIAMI HOSPITAL
Doing business as
INTEGRIS HOME CARE NORTHEAST
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jan 6, 1984
Last certification
Nov 27, 2018
Ownership / control type
Non-Profit
Organization structure
LLCNon-profit
Enrollment address
207 2ND Ave SW
Miami, OK 74354-6818

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Integris Home Care NortheastCCN 377050 · All quality measures
Overall star rating
3.5 of 5
Ownership
Non-Profit
Certified
Jan 6, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Alliance Private Duty5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

119 S Main St
Miami, OK 74354
Phone (918) 540-2577

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
James D Rutter Individual Corporate Director Jul 1, 2016
John Hampton Individual Corporate Director May 1, 2019
Donna M Wallace Individual Corporate OfficerAssistant Treasurer Oct 27, 2023
Rayetta L Dominguez Individual Contracted Managing EmployeeAd; Dec 13, 1999
Operational/Managerial ControlAdministrator Dec 13, 1999
Michael L Weed Individual Corporate Officer Jan 1, 2023
Casey Ahlden Individual Corporate Officer Jan 1, 2023
Charles a Neal Individual Corporate Director Jun 30, 2005
Integris Health Inc Organization, Oklahoma City, OK Corporation, Non-profit Operational/Managerial Control Jul 1, 1994
Brent Hubbard Individual Corporate Officer Jul 1, 2022
Corporate Director Jul 1, 2022
Justin Lee Mitchell Individual Corporate Officer Dec 1, 2019
James Perryman Individual Corporate Officer Jul 1, 2024
Corporate Director Jul 1, 2017
Jonas Rabel Individual Contracted Managing EmployeeChief Hospital Executive May 1, 2017
Corporate OfficerChief Hospital Executive May 1, 2017
Operational/Managerial ControlChief Hospital Executive May 1, 2017
Baptist Healthcare of Oklahoma LLC Organization, Oklahoma City, OK LLC, Non-profit Operational/Managerial Control Jun 7, 1978
Rene Galan Individual Corporate Officer Jul 1, 2024
Corporate Director Jul 1, 2024
Caleb Goldner Individual Corporate Director Jan 1, 2015
Grant Kernan Individual Corporate Officer Jul 1, 2023
Corporate Director Jan 1, 2015
David R Frazier Individual Corporate Officer Jul 1, 2024
Corporate Director Nov 1, 2017
Integris Rural Health Inc Organization, Oklahoma City, OK Corporation, Non-profit Operational/Managerial Control Jul 1, 1994
Patrick Jurgensmeyer Individual Corporate Director Jun 28, 2005
Timothy Pehrson Individual OtherChain Home Office Administrator Aug 1, 2018

Owners & managing parties with NPI records 3

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

Facilities with the same owner 31

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

View all 31

Practitioners & affiliated clinicians

Affiliated clinicians 19

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723161600000",
    "number": "1194748319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 200759",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753200759",
            "telephone_number": "405-252-8319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 2ND AVE SW",
            "city": "MIAMI",
            "state": "OK",
            "postal_code": "743546818",
            "telephone_number": "918-540-2577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRIS MIAMI HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "ASSISTANT TREASURER",
        "authorized_official_telephone_number": "636-359-4890"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100699440D",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integris Home Care Northeast",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Miami, OK

Sources for this page

Verify at the official NPI Registry.