NPIMap

Shortgrass Community Health Center, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Hollis, OK

NPI 1255695201 · NPPES record last updated Jun 25, 2012

Key facts

NPI
1255695201
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
SHORTGRASS COMMUNITY HEALTH CENTER, INC
Practice address
400 E Sycamore St
Hollis, OK 73550-1436
Phone
(580) 688-2800
Fax
(580) 688-2193
NPI assigned
Jun 25, 2012
Organization subpart
No

Authorized official

Name
Mrs. Janet Tipton
Title
Office Manager
Phone
(580) 688-2800

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 3

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

Practitioners 21

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in OK

Federally qualified health center certification: CCN 371884

Legal name
SHORTGRASS COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 13, 2012
Last certification
Sep 13, 2012
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Jun 30, 2009 in OK
Enrollment address
400 E Sycamore St
Hollis, OK 73550-1436

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Stella Reyes
Individual 		W-2 Managing Employee
Medical Assistant/Billing		 Jul 1, 2017
Paul Kelly Horton
Individual 		Corporate Director
Board Member		 Nov 10, 2015
David Johnson
Individual 		Corporate Director
Board Member		 Sep 15, 2014
Janet L Tipton
Individual 		W-2 Managing Employee
Clinic Manager		 Aug 20, 2012
Ginger a. Creech
Individual 		Corporate Director
Ceo		 Jul 7, 2016
Operational/Managerial Control
Ceo		 Jul 7, 2016
Dean E Crenshaw
Individual 		Corporate Director
Board-Vice President		 Aug 20, 2012
Beth Penington
Individual 		Corporate Director
Board Member		 Aug 1, 2017
Kimi M Copeland
Individual 		Corporate Officer
Board President		 Aug 20, 2012
Kerry Kurt Hudson
Individual 		Corporate Officer
Member		 Sep 1, 2018
Tiffany Zepy
Individual 		Corporate Director
Board Member		 Nov 30, 2016

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20120801000672 OK Part a Provider - Federally Qualified Health Center (FQHC) 9234385535 Practice locations: Hollis, OK
O20121101000597 OK Part B Supplier - Clinic/Group Practice 9234385535 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Altus, OK; Hollis, OK

National Provider Directory

Tax ID family
Shortgrass Community Health Center Inc (4 organizations share this tax ID)

Locations

101 S Hudson St
Altus, OK 73521
Phone (580) 301-6154

1115 Harbor Rd
Grove, OK 74344
Phone (918) 256-6476

400 E Sycamore St
Hollis, OK 73550
Phone (580) 688-2800

Interoperability endpoints

  • Direct secure messaging: eboniepankey@schc.secure.relimedsolutions.com
  • Direct secure messaging: kristifry@schc.secure.relimedsolutions.com
  • Direct secure messaging: ericadesantos@schc.secure.relimedsolutions.com
  • Direct secure messaging: kimberlyhestand@schc.secure.relimedsolutions.com
  • Direct secure messaging: kimberlycline@schc.secure.relimedsolutions.com
  • Direct secure messaging: brentdenley@schc.secure.relimedsolutions.com
  • Direct secure messaging: brianbauer@schc.secure.relimedsolutions.com

Specialties & licenses

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

Addresses

Primary practice location

400 E Sycamore St
Hollis, OK 73550-1436

Mailing address

400 E Sycamore St
Hollis, OK 73550-1436
Phone (580) 688-2800

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 25, 2012.

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340582400000",
    "number": "1255695201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E SYCAMORE ST",
            "city": "HOLLIS",
            "state": "OK",
            "postal_code": "735501436",
            "telephone_number": "580-688-2800",
            "fax_number": "580-688-2193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E SYCAMORE ST",
            "city": "HOLLIS",
            "state": "OK",
            "postal_code": "735501436",
            "telephone_number": "580-688-2800",
            "fax_number": "580-688-2193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORTGRASS COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-25",
        "last_updated": "2012-06-25",
        "status": "A",
        "authorized_official_last_name": "TIPTON",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "580-688-2800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollis, OK

All providers in Hollis, OK · Federally Qualified Health Center (FQHC) in Oklahoma

Sources for this page

Verify at the official NPI Registry.