NPIMap

Organization Active NPI

Triad Health Systems LLC

  • Family Medicine Physician
  • Ponca City, OK
National Provider Identifier
1245867258
Registry record updated Jun 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TRIAD HEALTH SYSTEMS LLC
Practice address
2703 N 14TH St
Ponca City, OK 74601
Phone
(580) 765-9451
NPI assigned
Mar 27, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2020

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

Authorized official

Name
Amy Beverley
Title
Billing Manager
Phone
(580) 765-9451

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2703 N 14TH St
Ponca City, OK 74601

Mailing address

2703 N 14TH St
Ponca City, OK 74601
Phone (580) 765-9451

Other names 1

  • TRIAD COMPLETE HEALTHCARE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200624002858 OK Part B Supplier - Clinic/Group Practice 1355763160 Receives reassigned benefits from 11 practitioners
Practice locations: Ardmore, OK; Ponca City, OK

National Provider Directory

National Provider Directory

Locations

2703 N 14th St
Ponca City, OK 74601
Phone (580) 749-7846

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21021/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1585267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591574400000",
    "number": "1245867258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2703 N 14TH ST",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "74601",
            "telephone_number": "580-765-9451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2703 N 14TH ST",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "74601",
            "telephone_number": "580-765-9451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD HEALTH SYSTEMS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-27",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A",
        "authorized_official_last_name": "BEVERLEY",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "580-765-9451"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TRIAD COMPLETE HEALTHCARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ponca City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2020; 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.