NPIMap

Organization Active NPI

Shortgrass Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Hollis, OK
National Provider Identifier
1255695201
Registry record updated Jun 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Jun 25, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2012

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

Authorized official

Name
Mrs. Janet TiptonNPI 1790557924
Title
Office Manager
Phone
(580) 688-2800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255695201. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jun 30, 2009 in OK
Enrollment address
400 E Sycamore St
Hollis, OK 73550-1436

Other NPIs with the same Medicare PAC ID 2

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.

National Provider Directory

National Provider Directory
Tax ID family
Shortgrass Community Health Center Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

230 E Jefferson St
Mangum, OK 73554
Phone (580) 782-2027

Interoperability endpoints

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

Ownership & related parties

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 EmployeeMedical Assistant/Billing Jul 1, 2017
Paul Kelly Horton Individual Corporate DirectorBoard Member Nov 10, 2015
David Johnson Individual Corporate DirectorBoard Member Sep 15, 2014
Janet L Tipton Individual W-2 Managing EmployeeClinic Manager Aug 20, 2012
Ginger a. Creech Individual Corporate DirectorCeo Jul 7, 2016
Operational/Managerial ControlCeo Jul 7, 2016
Dean E Crenshaw Individual Corporate DirectorBoard-Vice President Aug 20, 2012
Beth Penington Individual Corporate DirectorBoard Member Aug 1, 2017
Kimi M Copeland Individual Corporate OfficerBoard President Aug 20, 2012
Kerry Kurt Hudson Individual Corporate OfficerMember Sep 1, 2018
Tiffany Zepy Individual Corporate DirectorBoard Member Nov 30, 2016

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "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

Sources for this page

Verify at the official NPI Registry.