NPIMap

Organization Active NPI

Good Shepherd Community Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ardmore, OK
National Provider Identifier
1285010413
Registry record updated Feb 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GOOD SHEPHERD COMMUNITY CLINIC, INC.
Practice address
20 12TH Ave NW
Ardmore, OK 73401-5722
Phone
(580) 223-3411
Fax
(580) 223-6614
NPI assigned
Aug 11, 2015
Last updated
Feb 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2022

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

Authorized official

Name
Ms. Teresa Myers
Title
Ceo
Phone
(580) 223-3411

Specialties & licenses 1

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

Addresses

Primary practice location

20 12TH Ave NW
Ardmore, OK 73401-5722

Mailing address

20 12TH Ave NW
Ardmore, OK 73401-5722
Phone (580) 223-3411

Other practice location 1

1104 Walnut Dr
Ardmore, OK 73401-2353
Phone (580) 226-0543

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20160106000675 OK Part B Supplier - Clinic/Group Practice 4284936337 Receives reassigned benefits from 24 practitioners
Practice locations: Ardmore, OK
O20190225000900 OK Part A Provider - Federally Qualified Health Center (FQHC) 4284936337 Practice locations: Ardmore, OK
O20200928001458 OK Part A Provider - Federally Qualified Health Center (FQHC) 4284936337 Practice locations: Ardmore, OK
O20211112000350 OK Part A Provider - Federally Qualified Health Center (FQHC) 4284936337 Practice locations: Ardmore, OK
O20250304000103 OK Part A Provider - Federally Qualified Health Center (FQHC) 4284936337 Practice locations: Ardmore, OK

NPI to CCN mapping 4

The Medicare certification numbers (CCNs) connected to NPI 1285010413. Details of each certification follow.

Federally qualified health center certification: CCN 371939

Legal name
GOOD SHEPHERD COMMUNITY CLINIC, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 25, 2019
Last certification
Feb 25, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 26, 1996 in OK
Enrollment address
20 12TH Ave NW
Ardmore, OK 73401-5722

Federally qualified health center certification: CCN 371958

Legal name
GOOD SHEPHERD COMMUNITY CLINIC, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 23, 2020
Last certification
Sep 23, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 26, 1996 in OK
Enrollment address
1104 Walnut Dr
Ardmore, OK 73401-2353

Federally qualified health center certification: CCN 371973

Legal name
GOOD SHEPHERD COMMUNITY CLINIC, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 15, 2021
Last certification
Nov 15, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 5, 2010 in OK
Enrollment address
1116 Walnut Dr
Ardmore, OK 73401-2353

Federally qualified health center certification: CCN 371047

Legal name
GOOD SHEPHERD COMMUNITY CLINIC, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 24, 2025
Last certification
Jan 24, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
2401 N Commerce St
Ardmore, OK 73401-1311

National Provider Directory

National Provider Directory

Locations

1116 Walnut Dr
Ardmore, OK 73401
Phone (580) 226-0543

1520 N Commerce St
Ardmore, OK 73401
Phone (580) 226-1244

2401 N Commerce St
Ste A
Ardmore, OK 73401
Phone (580) 798-4122

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Teresa Myers Individual Corporate DirectorExecutive Director Apr 16, 2014 100%
W-2 Managing EmployeeExecutive Director Apr 16, 2014 100%
Operational/Managerial ControlCeo Mar 1, 2014 100%
Corporate OfficerCeo Mar 1, 2014 100%
Corporate OfficerCeo Nov 19, 2015 100%
Corporate DirectorCeo Nov 19, 2015 100%
Operational/Managerial ControlCeo Nov 19, 2015 100%
Good Shepherd Community Clinic, Inc. Organization, Ardmore, OK Non-profit 5% Or Greater Direct Ownership Interest Aug 1, 2020 100%

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645488000000",
    "number": "1285010413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 12TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734015722",
            "telephone_number": "580-223-3411",
            "fax_number": "580-223-6614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 12TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734015722",
            "telephone_number": "580-223-3411",
            "fax_number": "580-223-6614"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1104 Walnut Dr",
            "address_purpose": "LOCATION",
            "city": "Ardmore",
            "state": "OK",
            "postal_code": "734012353",
            "country_code": "US",
            "telephone_number": "580-226-0543",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GOOD SHEPHERD COMMUNITY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-11",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-223-3411",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

Verify at the official NPI Registry.