Integris South Oklahoma City Hospital Corporation
Organization Active NPI Mammography Clinic/Center · Oklahoma City, OK
NPI 1336155779 · NPPES record last updated May 11, 2010
Key facts
- NPI
- 1336155779
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mammography Clinic/Center 261QR0206X
- License
- 2289 (OK)
- Legal business name
- INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION
- Practice address
- 4100 S Douglas Ave
Oklahoma City, OK 73109-3210 - Phone
- (405) 636-7480
- NPI assigned
- Jul 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Stanely Hupfeld
- Title
- President/Ceo
- Phone
- (405) 949-6066
Owners & managing parties with NPI records 6
-
Arun K Devakonda, MD
-
Chelsey Dee Gilbertson, D.O.
-
Anthony D Jackson, M.D.
-
Jeanette Marie Kelley, D.O.
-
Brian Seacat, MD
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 3
Related certifications (CCN) 1
Practitioners 4
-
Stacy Ann Bockelman, OTR/L
-
Tiffany Lee Rea, M.S. CCC-SLP
-
Lori Ann Smith, OTR/L
-
Kathryn Heather Voskuhl, P.T.
Affiliated clinicians 613
-
Syed A. Abbas, M.D.
-
Sarah Michelle Adams, D.O.
-
Bilal Ahmad, M.D
-
Mohsin Ahmad, MD
-
Saeed Ahmad, M.D.
-
Mackenzie Lynn Ainsworth, FNP-C
-
Bushra Akram, MD
-
Bashar Samir Alasad, M.D.
-
Abdulmawla Albirini, M.D.
-
Bereket Alemu, M.D
-
Fazal Akbar Ali, MD
-
Hamsa Aljumaili, MD
-
Henry M Allen, D.O.
-
Nicole Jeanne Alvarez, CRNA
-
Aly E Aly, MD
-
Serena Anderson, M.D.
-
James Edward Applebury, M.D.
Medicare Care Compare: Hospital
- Listed as
- Integris Southwest Medical Center
- Overall star rating
- ★★☆☆☆ 2 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
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
- Corporation · Non-profit
- Incorporated
- Jul 2, 1996 in OK
- Enrollment address
- 4401 S Western Ave
Oklahoma City, OK 73109-3413 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Scott Bulmer |
Corporate Director |
Jan 1, 2002 | |
| Jennifer Tucker |
Corporate Director |
Jul 1, 2015 | |
| Chris M Hammes |
Corporate Officer |
Feb 1, 2017 | |
| W-2 Managing Employee |
Feb 1, 2017 | ||
| Anthony D Jackson |
Corporate Director |
Jul 1, 2014 | |
| Stephen Buchanan |
Corporate Director |
Jan 1, 2004 | |
| Philip Nmi Mosca |
Corporate Director |
Jan 1, 1993 | |
| David B Tipton |
Corporate Director |
Oct 28, 2014 | |
| Arun K Devakonda |
Corporate Director |
Jul 1, 2019 | |
| Chelsey D Gilbertson |
Corporate Director |
Jan 1, 2021 | |
| Michael L Weed |
Corporate Director | Nov 19, 2018 | |
| W-2 Managing Employee |
Nov 19, 2018 | ||
| Integris Health Inc |
5% Or Greater Direct Ownership Interest | Nov 8, 1995 | 100% |
| Karla Marshall |
Corporate Director |
Jan 1, 2007 | |
| Derek B Gill |
Corporate Director |
Jan 1, 2009 | |
| Renee Porter |
Corporate Director |
Jul 1, 2019 | |
| Brian Christopher Seacat |
Corporate Director |
Jul 1, 2020 | |
| Vincent Bridges |
Corporate Director |
Jul 1, 2020 | |
| Donald C Turner |
Corporate Director |
Jan 1, 1995 | |
| Jeannette Kelley |
Corporate Director |
Jul 1, 2021 | |
| Timothy Pehrson |
W-2 Managing Employee |
Aug 1, 2018 | |
| John Henry Adams |
Corporate Director | Jul 1, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Southwest Medical Cente
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mammography Clinic/Center | 261QR0206X | 2289 | OK | Yes |
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
- Integris Southwest Breast Center
Other providers in Oklahoma City, OK
- Integris Prohealth Inc
- Integris Prohealth Inc
- Integris Prohealth Inc
- Integris South Oklahoma City Corporation
- Integris South Oklahoma City Hospital Corp Dba Ismc Hospitalists
- Integris South Oklahoma City Hospital Corporation
- Integris South Oklahoma City Hospital Corporation
- Integris South Oklahoma City Hospital Corporation
- Integris South Oklahoma City Hospital Corporation
- Integris Southwest Associates
All providers in Oklahoma City, OK · Mammography Clinic/Center in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2010. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.