Central Oklahoma Family Medical Center Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Ada, OK
NPI 1295500429 · NPPES record last updated Mar 1, 2024
Key facts
- NPI
- 1295500429
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CENTRAL OKLAHOMA FAMILY MEDICAL CENTER INC
- Practice address
- 304 N Monte Vista Street
Ada, OK 74820-7484 - Phone
- (580) 436-5111
- Fax
- (580) 925-9147
- NPI assigned
- Nov 17, 2023
- Organization subpart
- No
Authorized official
- Name
- Brenda Ware
- Title
- Ceo
- Phone
- (580) 925-3286
Owned or controlled facilities with NPI records 10
Other NPIs with the same Medicare PAC ID 14
Corporate family (same tax ID) 30
Practitioners 57
-
Melissa Lynn Adams, D.P.M
-
Jody Wayne Ardrey, ARNP-CNP
-
Lynn Dean Baggett, M.D.
-
Gayla Beth Branscum, LMHP
-
Justin Burnett, MD
-
Penni Cartlidge, APRN-CNP
-
Charlysa Diana Gatlin Castillo, APRN CNP
-
Semira Charboneau, D.O.
-
Lindsey Sue Conner, APRN
-
Michel Danette Cosby, APRN
-
Amanda Lynn Cubit, NP-C
-
Emily Nicole Davis, APRN-CNP
-
Kyndel Dillard, PA-C
-
Laura Lindsey Dooley, ARNP
-
John Keith Falsarella, M.D.
-
Robyn D Freeland, PA C
-
Jenna Geohagan, M.D.
-
Curtis E Harris, MD
-
Amber Holbein, MD
-
Brooke Nicole Houck, APRN-CNM, WHNP- BC
-
Annika Marie Jennings, APRN-CNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Federally qualified health center certification: CCN 371037
- Legal name
- CENTRAL OKLAHOMA FAMILY MEDICAL CENTER INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 24, 2024
- Last certification
- Jul 24, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 304 N Monte Vista St
Ada, OK 74820
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Carla Presley |
Corporate Officer |
Aug 1, 2017 | |
| Marie Prewett |
Corporate Officer |
Feb 1, 2009 | |
| John Netherton |
Corporate Officer |
Sep 1, 2023 | |
| Nancy Wilson |
Corporate Officer | Sep 1, 2017 | |
| Meagan Brooking |
Corporate Officer |
Aug 1, 2017 | |
| Brenda Ware |
Corporate Officer |
Mar 25, 2002 | |
| W-2 Managing Employee |
Mar 25, 2002 | ||
| Ramona Bunch |
Corporate Officer |
Jan 1, 2012 | |
| Barry Streetman |
Corporate Officer | May 1, 2004 | |
| Billy Potts |
Corporate Officer |
Jun 1, 1990 | |
| Judy Cantrell |
Corporate Officer |
Jul 1, 2018 | |
| Susan Coleman |
Corporate Officer |
Jul 1, 2016 |
All facility ownership & control disclosures 10
| Facility | Type | Role | Since |
|---|---|---|---|
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Jul 1, 1986 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 1, 2019 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Mar 25, 2002 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | Sep 1, 2021 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | Sep 1, 2021 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | Jan 11, 2022 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | May 3, 2022 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | Jun 1, 2022 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | Feb 1, 2022 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Mar 25, 2002 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240717000179 | OK | Part a Provider - Federally Qualified Health Center (FQHC) | 9931189685 | Practice locations: Ada, OK |
National Provider Directory
- Tax ID family
- Central Ok Family Med Ctr
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health Dentistry |
1223D0001X | |||
| Dental Clinic/Center | 261QD0000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
304 N Monte Vista Street
Ada, OK 74820-7484
Mailing address
527 W 3Rd St
Konawa, OK 74849-1415
Phone (580) 925-3286
Other providers in Ada, OK
- Charlysa Diana Gatlin Castillo
- Pamela Marie Catalano
- Sharell Clydean Caton
- Mindy Caudill
- Central Oklahoma Family Medical Center Inc
- Central Oklahoma Family Medical Center Inc
- Central Oklahoma Family Medical Center Inc
- Central Oklahoma Family Medical Center Inc
- Central Oklahoma Family Medical Center Inc
- Central Oklahoma Family Medical Center Inc
All providers in Ada, OK · Federally Qualified Health Center (FQHC) in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.