NPIMap

Organization Active NPI

Integris South Oklahoma City Hospital Corporation

Doing business as Integris Southwest Breast Center

  • Mammography Clinic/Center
  • Oklahoma City, OK
National Provider Identifier
1336155779
Registry record updated May 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mammography Clinic/CenterTaxonomy code 261QR0206X
License
2289 Issued in OK
Legal business name
INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION
Doing business as
Integris Southwest Breast Center
Practice address
4100 S Douglas Ave
Oklahoma City, OK 73109-3210
Phone
(405) 636-7480
NPI assigned
Jul 31, 2006
Last updated
May 11, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2010

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

Authorized official

Name
Stanely Hupfeld
Title
President/Ceo
Phone
(405) 949-6066

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mammography Clinic/Center 261QR0206X 2289 OK Primary

Addresses

Primary practice location

4100 S Douglas Ave
Oklahoma City, OK 73109-3210

Mailing address

5400 N Independence Ave
100
Oklahoma City, OK 73112-5300

Other names 1

  • Integris Southwest Breast Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080130000111 OK Part A Provider - Hospital 9739089772 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oklahoma City, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336155779. Details of each certification follow.

Hospital certification: CCN 370106

Legal name
INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION
Doing business as
INTEGRIS SOUTHWEST MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jan 7, 2022
Beds
334
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jul 2, 1996 in OK
Enrollment address
4401 S Western Ave
Oklahoma City, OK 73109-3413
Other Hospital Practice Location
Hospital subgroups
Acute care

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Integris Southwest Medical CenterCCN 370106 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Integris Southwest Med4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Scott Bulmer Individual Corporate DirectorBoard Member Jan 1, 2002
Jennifer Tucker Individual Corporate DirectorBoard Member Jul 1, 2015
Chris M Hammes Individual Corporate OfficerInterim Ceo, Exec VP & Coo Feb 1, 2017
W-2 Managing EmployeeInterim Ceo, Exec VP & Coo Feb 1, 2017
Anthony D Jackson Individual Corporate DirectorBoard Member Jul 1, 2014
Stephen Buchanan Individual Corporate DirectorBoard Member Jan 1, 2004
Philip Nmi Mosca Individual Corporate DirectorBoard Member Jan 1, 1993
David B Tipton Individual Corporate DirectorBoard Member Oct 28, 2014
Arun K Devakonda Individual Corporate DirectorBoard Member Jul 1, 2019
Chelsey D Gilbertson Individual Corporate DirectorBoard Member Jan 1, 2021
Michael L Weed Individual Corporate Director Nov 19, 2018
W-2 Managing EmployeeVP Operations Nov 19, 2018
Integris Health Inc Organization, Oklahoma City, OK Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 8, 1995 100%
Karla Marshall Individual Corporate DirectorBoard Member Jan 1, 2007
Derek B Gill Individual Corporate DirectorBoard Member Jan 1, 2009
Renee Porter Individual Corporate DirectorBoard Member Jul 1, 2019
Brian Christopher Seacat Individual Corporate DirectorBoard Member Jul 1, 2020
Vincent Bridges Individual Corporate DirectorBoard Member Jul 1, 2020
Donald C Turner Individual Corporate DirectorBoard Member Jan 1, 1995
Jeannette Kelley Individual Corporate DirectorBoard Member Jul 1, 2021
Timothy Pehrson Individual W-2 Managing EmployeeCeo Aug 1, 2018
John Henry Adams Individual Corporate Director Jul 1, 2020

Owners & managing parties with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 4

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.

Affiliated clinicians 613

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

View all 613

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273536000000",
    "number": "1336155779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 N INDEPENDENCE AVE",
            "address_2": "100",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731125300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 S DOUGLAS AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731093210",
            "telephone_number": "405-636-7480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2010-05-11",
        "status": "A",
        "authorized_official_last_name": "HUPFELD",
        "authorized_official_first_name": "STANELY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "405-949-6066"
    },
    "taxonomies": [
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": "OK",
            "license": "2289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integris Southwest Breast Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.