NPIMap

Organization Active NPI

Citizen Potawatomi Nation

Doing business as Citizen Potawatomi Nation Clinic

  • Federally Qualified Health Center (FQHC)
  • Shawnee, OK
National Provider Identifier
1194752949
Registry record updated Feb 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CITIZEN POTAWATOMI NATION
Doing business as
Citizen Potawatomi Nation Clinic
Practice address
2307 S Gordon Cooper Dr
Shawnee, OK 74801-9007
Phone
(405) 273-5236
Fax
(405) 878-4835
NPI assigned
Jun 27, 2006
Last updated
Feb 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2025

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

Authorized official

Name
Mr. Chris Skillings
Title
Director of Health Services
Phone
(405) 273-5236

Specialties & licenses 1

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

Addresses

Primary practice location

2307 S Gordon Cooper Dr
Shawnee, OK 74801-9007

Mailing address

2307 S Gordon Cooper Dr
Shawnee, OK 74801-9007
Phone (405) 273-5236

Other identifiers 1

IdentifierTypeStateIssuer
100244300CMedicaidOK

Other names 1

  • Citizen Potawatomi Nation Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101004000641 OK Part A Provider - Federally Qualified Health Center (FQHC) 3375511488 Practice locations: Shawnee, OK
O20140123000876 TX Part B Supplier - Clinic/Group Practice 3375511488 Receives reassigned benefits from 53 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Shawnee, OK; Tecumseh, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194752949. Details of each certification follow.

Federally qualified health center certification: CCN 371825

Legal name
CITIZEN POTAWATOMI NATION
Doing business as
CITIZEN POTAWATOMI NATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1997
Last certification
Jan 1, 1997
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
2307 Gordon Cooper Dr
Shawnee, OK 74801-9007

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

2307 Gordon Cooper Dr
Shawnee, OK 74801
Phone (405) 273-5236

Interoperability endpoints

  • FHIR API: https://epicproxy.et1447.epichosted.com/APIProxyPRD/api/FHIR/R4

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Chris Skillings Individual Corporate Director Jul 1, 2016
Aubry Bennett Individual W-2 Managing Employee Feb 11, 2022
Citizen Potawatomi Nation Organization, Shawnee, OK Non-profit Operational/Managerial Control Jul 29, 2010 100%
John Barrett Individual Corporate Director Dec 1, 1996
Linda Capps Individual Corporate Director Dec 1, 1996

Owners & managing parties with NPI records 1

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
Citizen Potawatomi Nation West ClinicShawnee, OK, CCN 371877 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 10, 2011

Owned or controlled facilities with NPI records 1

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

  • Citizen Potawatomi Nation

    dba Citizen Potawatomi Nation West Clinic

    • Federally Qualified Health Center (FQHC)
    • Shawnee, OK
    • NPI 1881981744

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740700800000",
    "number": "1194752949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2307 S GORDON COOPER DR",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748019007",
            "telephone_number": "405-273-5236",
            "fax_number": "405-878-4835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2307 S GORDON COOPER DR",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748019007",
            "telephone_number": "405-273-5236",
            "fax_number": "405-878-4835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIZEN POTAWATOMI NATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-27",
        "last_updated": "2025-02-28",
        "certification_date": "2025-02-28",
        "status": "A",
        "authorized_official_last_name": "SKILLINGS",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "DIRECTOR OF HEALTH SERVICES",
        "authorized_official_telephone_number": "405-273-5236",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100244300C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Citizen Potawatomi Nation Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shawnee, OK

Sources for this page

Verify at the official NPI Registry.