NPIMap

Organization Active NPI

Northeastern Health System

Doing business as Tahlequah Medical Group Primary Care

  • Rural Health Clinic/Center
  • Tahlequah, OK
National Provider Identifier
1306387949
Registry record updated Apr 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
NORTHEASTERN HEALTH SYSTEM
Doing business as
Tahlequah Medical Group Primary Care
Practice address
1201 E Ross Byp
Tahlequah, OK 74464-4188
Phone
(918) 207-0991
Fax
(918) 456-7570
NPI assigned
Mar 15, 2017
Last updated
Apr 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2026

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

Authorized official

Name
Julie Ward
Title
Cfo
Phone
(918) 453-2120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1201 E Ross Byp
Tahlequah, OK 74464-4188

Mailing address

PO Box 500
Tahlequah, OK 74465-0500
Phone (918) 207-0991

Other names 1

  • Tahlequah Medical Group Primary Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050519001008 OK Part A Provider - Hospital 1456255025 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tahlequah, OK
O20170605000616 OK Part A Provider - Rural Health Clinic 1456255025 1 other NPI on this enrollment
Practice locations: Tahlequah, OK

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1306387949. Details of each certification follow.

Hospital certification: CCN 370089

Legal name
NORTHEASTERN HEALTH SYSTEM
Doing business as
TAHLEQUAH CITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jun 4, 2025
Beds
98
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Enrollment address
1400 E Downing St
Tahlequah, OK 74464-3324
Other Hospital Practice Location
Hospital subgroups
General

Rural health clinic certification: CCN 378503

Legal name
NORTHEASTERN HEALTH SYSTEM
Doing business as
TAHLEQUAH MEDICAL GROUP PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 31, 2017
Last certification
Feb 10, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 3, 1974 in OK
Enrollment address
1201 E Ross Byp
Tahlequah, OK 74464-4188
Related CCNs
370089

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

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Northeastern Health SystemCCN 370089 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D1058618Tahlequah Medical Group Primary Care1201 E Ross Bypass, Tahlequah, OK 74464Provider-performed microscopyDec 25, 2026

National Provider Directory

National Provider Directory
Tax ID family
Tahlequah City Hospital7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

1201 E Ross Byp
Ste 1
Tahlequah, OK 74464
Phone (918) 207-0991

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
James Berry Individual Corporate OfficerVP Sep 1, 2016
Corporate OfficerVP Jun 1, 2017 50%
W-2 Managing EmployeeVP Jun 1, 2017 50%
Northeastern Health System Organization, Tahlequah, OK Operational/Managerial Control May 1, 2008
Brian Woodliff Individual Corporate Director May 19, 2005
W-2 Managing Employee May 19, 2005
Christine Jankas Individual Corporate OfficerVP Physician Services May 14, 2019

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Tahlequah City HospitalTahlequah, OK, CCN 370089 Hospital Operational/Managerial Control May 1, 2008
Tahlequah City HospitalTahlequah, OK, CCN 37S089 Hospital Operational/Managerial Control Oct 1, 2002
Tahlequah City HospitalTahlequah, OK, CCN 37T089 Hospital Operational/Managerial Control Jan 1, 1974

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 146

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 146

Affiliated clinicians 335

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 335

NPI Registry JSON

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

{
    "created_epoch": "1489536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775433600000",
    "number": "1306387949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 500",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744650500",
            "telephone_number": "918-207-0991",
            "fax_number": "918-456-7570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 E ROSS BYP",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744644188",
            "telephone_number": "918-207-0991",
            "fax_number": "918-456-7570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-15",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-06",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "918-453-2120"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tahlequah Medical Group Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tahlequah, OK

Sources for this page

Verify at the official NPI Registry.