NPIMap

Organization Active NPI

Northeastern Oklahoma Community Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Tahlequah, OK
National Provider Identifier
1376513002
Registry record updated Jun 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS INC
Practice address
1310 E Boone St
Tahlequah, OK 74464-3338
Phone
(918) 456-7700
Fax
(918) 458-9314
NPI assigned
Jan 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2020

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

Authorized official

Name
Scott Rosenthal
Title
Ceo
Phone
(918) 772-3390

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1310 E Boone St
Tahlequah, OK 74464-3338

Mailing address

PO Box 751
Hulbert, OK 74441-0751
Phone (918) 772-3390

Other identifiers 1

IdentifierTypeStateIssuer
200057760AMedicaidOK

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031104000417 OK Part B Supplier - Clinic/Group Practice 3678482635 Receives reassigned benefits from 70 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Westville, OK; Tahlequah, OK; Salina, OK; Pryor, OK; Muskogee, OK; Hulbert, OK
O20181127000826 OK Part A Provider - Federally Qualified Health Center (FQHC) 3678482635 Practice locations: Tahlequah, OK

Federally qualified health center certification: CCN 371935

Legal name
NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, INC
Doing business as
TAHLEQUAH PEDIATRICS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 27, 2018
Last certification
Nov 27, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 3, 2001 in OK
Enrollment address
1310 E Boone St
Tahlequah, OK 74464-3338

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 13

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

View all 13

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
37D1043399Tahlequah Pediatrics1310 E Boone, Tahlequah, OK 74464Certificate of waiverJun 16, 2028

National Provider Directory

National Provider Directory
Tax ID family
NE Ok Comm HLTH Ctr Inc16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

1310 E Boone St
Tahlequah, OK 74464
Phone (918) 456-7700

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
Luann Hudson Individual Corporate OfficerBoard Member Jun 19, 2019
Joann Bradley Individual Corporate OfficerBoard Member Dec 1, 2011
Scott Rosenthal Individual Corporate OfficerCeo Feb 12, 2015
Corporate DirectorCeo Dec 1, 2012 100%
W-2 Managing EmployeeCeo Dec 1, 2012
Joan Foster Individual Corporate OfficerBoard Member Dec 1, 2011
Courtney Hamby Individual Corporate OfficerBoard Member Jun 1, 2016
Timothy M Booth Individual Corporate OfficerBoard Member Sep 1, 2012
Josh Stafford Individual Corporate OfficerBoard Member Dec 1, 2014
Crystal Steed Individual Corporate OfficerCoo Dec 1, 2012
Beverly Runnels Individual Corporate OfficerBoard Member Sep 27, 2011
Anthony Ward Individual Corporate OfficerBoard Member Dec 27, 2018
Trena Payton Individual Corporate OfficerBoard Member Jul 28, 2016

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Neohealth Tahlequah Health CenterTahlequah, OK, CCN 371867 Federally qualified health center Operational/Managerial Control Jan 1, 2011
Neohealth OB/GYNTahlequah, OK, CCN 371868 Federally qualified health center Operational/Managerial Control Jan 1, 2011
Neohealth Westville Family Medical CenterWestville, OK, CCN 371869 Federally qualified health center Operational/Managerial Control Sep 1, 2010
Neohealth Tahlequah Primary CareTahlequah, OK, CCN 371967 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2012
Pryor Family Medical CenterPryor, OK, CCN 371980 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2012

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 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591660800000",
    "number": "1376513002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751",
            "city": "HULBERT",
            "state": "OK",
            "postal_code": "744410751",
            "telephone_number": "918-772-3390",
            "fax_number": "918-772-3638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 E BOONE ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643338",
            "telephone_number": "918-456-7700",
            "fax_number": "918-458-9314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-25",
        "last_updated": "2020-06-09",
        "certification_date": "2020-06-09",
        "status": "A",
        "authorized_official_last_name": "ROSENTHAL",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-772-3390"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200057760A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tahlequah, OK

Sources for this page

Verify at the official NPI Registry.