NPIMap

Organization Active NPI

Central Oklahoma Family Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Ada, OK
National Provider Identifier
1295500429
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Mar 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Authorized official

Name
Brenda Ware
Title
Ceo
Phone
(580) 925-3286

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223D0001X
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240717000179 OK Part A Provider - Federally Qualified Health Center (FQHC) 9931189685 Practice locations: Ada, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295500429. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
304 N Monte Vista St
Ada, OK 74820

Other NPIs with the same Medicare PAC ID 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Cletas Cottage Day Treatment Center32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

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

View all 31

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Carla Presley Individual Corporate OfficerBoard Member Aug 1, 2017
Marie Prewett Individual Corporate OfficerBoard Member Feb 1, 2009
John Netherton Individual Corporate OfficerBoard Member Sep 1, 2023
Nancy Wilson Individual Corporate Officer Sep 1, 2017
Meagan Brooking Individual Corporate OfficerBoard Member Aug 1, 2017
Brenda Ware Individual Corporate OfficerCeo Mar 25, 2002
W-2 Managing EmployeeCeo Mar 25, 2002
Ramona Bunch Individual Corporate OfficerBoard Member Jan 1, 2012
Barry Streetman Individual Corporate Officer May 1, 2004
Billy Potts Individual Corporate OfficerBoard Member Jun 1, 1990
Judy Cantrell Individual Corporate OfficerBoard Member Jul 1, 2018
Susan Coleman Individual Corporate OfficerBoard Member Jul 1, 2016

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Central Oklahoma Family Medical Center IncAda, OK, CCN 371936 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 1986
Central Oklahoma Family Medical Center IncStratford, OK, CCN 371948 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2019
Central Oklahoma Family Medical Center IncAda, OK, CCN 371965 Federally qualified health center Operational/Managerial Control (100%) Mar 25, 2002
Central Oklahoma Family Medical Center IncAda, OK, CCN 371969 Federally qualified health center Operational/Managerial Control Sep 1, 2021
Central Oklahoma Family Medical Center IncAda, OK, CCN 371972 Federally qualified health center Operational/Managerial Control Sep 1, 2021
Central Oklahoma Family Medical Center IncAda, OK, CCN 371976 Federally qualified health center Operational/Managerial Control Jan 11, 2022
Central Oklahoma Family Medical Center IncSeminole, OK, CCN 371977 Federally qualified health center Operational/Managerial Control May 3, 2022
Central Oklahoma Family Medical Center IncAda, OK, CCN 371978 Federally qualified health center Operational/Managerial Control Jun 1, 2022
Central Oklahoma Family Medical Center IncAda, OK, CCN 371979 Federally qualified health center Operational/Managerial Control Feb 1, 2022
Central Oklahoma Family Medical Center IncSeminole, OK, CCN 371005 Federally qualified health center Operational/Managerial Control (100%) Mar 25, 2002

Owned or controlled facilities with NPI records 10

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

NPI Registry JSON

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

{
    "created_epoch": "1700179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1295500429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 W 3RD ST",
            "city": "KONAWA",
            "state": "OK",
            "postal_code": "748491415",
            "telephone_number": "580-925-3286",
            "fax_number": "580-925-2362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 N MONTE VISTA STREET",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748207484",
            "telephone_number": "580-436-5111",
            "fax_number": "580-925-9147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL OKLAHOMA FAMILY MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-17",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "WARE",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-925-3286"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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 Ada, OK

Sources for this page

Verify at the official NPI Registry.