NPIMap

Organization Active NPI

Carnegie Tri-County Municipal Hospital Management, Inc

  • General Practice Physician
  • Carnegie, OK
National Provider Identifier
1275657017
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
102 Issued in OK
Legal business name
CARNEGIE TRI-COUNTY MUNICIPAL HOSPITAL MANAGEMENT, INC
Practice address
102 N. Broadway
Carnegie, OK 73015
Phone
(580) 654-1050
Fax
(580) 654-2111
NPI assigned
Mar 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Authorized official

Name
Mr. Shane Bradley Dunning
Title
Ceo
Phone
(580) 654-1050

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X 102 OK Primary
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

102 N. Broadway
Carnegie, OK 73015

Mailing address

PO Box 97
Carnegie, OK 73015
Phone (580) 654-1050

Other identifiers 1

IdentifierTypeStateIssuer
100699690CMedicaidOK

Other names 1

  • Carnegie Tri-County Municipal Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050429000480 OK Part B Supplier - Clinic/Group Practice 6800835935 Receives reassigned benefits from 52 practitioners
Practice locations: Carnegie, OK
O20200922001998 OK Part A Provider - Rural Health Clinic 6800835935 Practice locations: Carnegie, OK

Rural health clinic certification: CCN 378542

Legal name
CARNEGIE TRI-COUNTY MUNICIPAL HOSPITAL MANAGEMENT INC
Doing business as
CARNEGIE MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 30, 2020
Last certification
Sep 10, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 21, 1996 in OK
Enrollment address
101 W Ash St
Carnegie, OK 73015-5013
Related CCNs
371334

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Thomas Newton Henton Individual Corporate OfficerChief Executive Officer Jan 1, 2019
Chastity Sink Individual W-2 Managing EmployeeRevenue Cycle Manager Aug 15, 2020
Carnegie Tri-County Municipal Hospital Management Inc Organization, Carnegie, OK Corporation, Non-profit Operational/Managerial Control Mar 14, 2016
Carnegie Tri County Municipal Hospital Authority Organization, Carnegie, OK Created for acquisition 5% Or Greater Direct Ownership Interest Apr 1, 2005 100%

Owners & managing parties with NPI records 2

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
Carnegie Tri-County Municipal HospitalCarnegie, OK, CCN 371334 Hospital Operational/Managerial Control Mar 14, 2016

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 61

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

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615248000000",
    "number": "1275657017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97",
            "city": "CARNEGIE",
            "state": "OK",
            "postal_code": "73015",
            "telephone_number": "580-654-1050",
            "fax_number": "580-654-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 N. BROADWAY",
            "city": "CARNEGIE",
            "state": "OK",
            "postal_code": "73015",
            "telephone_number": "580-654-1050",
            "fax_number": "580-654-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARNEGIE TRI-COUNTY MUNICIPAL HOSPITAL MANAGEMENT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A",
        "authorized_official_last_name": "DUNNING",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "BRADLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-654-1050",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "OK",
            "license": "102",
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100699690C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carnegie Tri-County Municipal Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Carnegie Tri-County Municipal Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carnegie, OK

Sources for this page

Verify at the official NPI Registry.