NPIMap

Organization Active NPI

Wagoner Hospital Authority

  • General Acute Care Hospital
  • Wagoner, OK
National Provider Identifier
1386611580
Registry record updated Apr 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
2298 Issued in OK
Legal business name
WAGONER HOSPITAL AUTHORITY
Practice address
1200 W Cherokee St
Wagoner, OK 74467-4624
Phone
(918) 485-5514
Fax
(918) 485-9701
NPI assigned
Mar 7, 2006
Last updated
Apr 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2021

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

Authorized official

Name
Debi Hamilton
Title
Chairman
Phone
(918) 485-5514

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 2298 OK Primary

Addresses

Primary practice location

1200 W Cherokee St
Wagoner, OK 74467-4624

Mailing address

1200 W Cherokee St
Wagoner, OK 74467-4624
Phone (918) 485-5514

Other practice location 1

3501 W Broadway St
Muskogee, OK 74401-2138
Phone (918) 913-9408

Other identifiers 3

IdentifierTypeStateIssuer
200100890BMedicaidOK
200100890AOtherOKMEDICAID PROVIDER NUMBER FOR PHYSICIAN BILLING
300522264OtherOKMEDICARE CLINIC PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20061025000585 OK Part A Provider - Hospital 0042217531 1 other NPI on this enrollment
Practice locations: Wagoner, OK
O20061214000095 OK Part B Supplier - Clinic/Group Practice 0042217531 Receives reassigned benefits from 29 practitioners
2 other NPIs on this enrollment
Practice locations: Wagoner, OK
O20240402003445 OK Part A Provider - Hospital 0042217531 Practice locations: Wagoner, OK

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1386611580. Details of each certification follow.

Hospital certification: CCN 370166

Legal name
WAGONER HOSPITAL AUTHORITY
Doing business as
WAGONER COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
May 1, 1973
Last certification
Jan 26, 2023
Beds
100
Ownership / control type
Hospital district or authority
Most recent change of ownership
Oct 1, 2007 (7 total)
Organization structure
OtherNon-profit
Enrollment address
1200 W Cherokee St
Wagoner, OK 74467-4624
Other Hospital Practice Location
Hospital subgroups
Acute care, Swing-bed approved

Hospital certification: CCN 37U166

Legal name
WAGONER HOSPITAL AUTHORITY
Doing business as
WAGONER COMMUNITY HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
1200 W Cherokee St
Wagoner, OK 74467-4624
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

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

Other NPIs with the same Medicare PAC ID 1

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

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
Wagoner Community HospitalCCN 370166 · 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
37D2344515Wagoner Community Hospital Nursing Dept1200 West Cherokee St, Wagoner, OK 74467Certificate of waiverMay 25, 2028

National Provider Directory

National Provider Directory
Tax ID family
Wagoner Orthopedic Center4 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 8

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

NameRoleSinceShare
Debi Hamilton Individual Corporate DirectorBoard of Trustees Chairman Jul 1, 2011
Corporate DirectorBoard of Trustees Chairman Dec 1, 2011
Mary Whisnant Individual OtherSecretary of Board May 1, 2009
Srinivas Katta Individual Corporate OfficerChairman/Quality Improvement Commit May 1, 2021
OtherBoard Member May 1, 2021
Corporate OfficerChairman/Quality Improvement Com May 1, 2021
David H Good Individual Corporate OfficerChief of Staff May 15, 2019
OtherBoard Member May 15, 2019
Bryan Casey Hanna Individual OtherBoard Member Aug 1, 2021
Mark Pointer Individual OtherBoard Member Jan 1, 2012
Kimberly Johnson Individual OtherBoard Member Aug 1, 2012
Jimmy Leopard Individual Corporate OfficerCeo Mar 1, 2007
W-2 Managing EmployeeCeo Mar 1, 2007

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 35

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 35

Affiliated clinicians 51

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

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619481600000",
    "number": "1386611580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W CHEROKEE ST",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744674624",
            "telephone_number": "918-485-5514",
            "fax_number": "918-485-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W CHEROKEE ST",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744674624",
            "telephone_number": "918-485-5514",
            "fax_number": "918-485-9701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3501 W Broadway St",
            "address_purpose": "LOCATION",
            "city": "Muskogee",
            "state": "OK",
            "postal_code": "744012138",
            "country_code": "US",
            "telephone_number": "918-913-9408",
            "fax_number": "918-913-9410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WAGONER HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-07",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "DEBI",
        "authorized_official_title_or_position": "CHAIRMAN",
        "authorized_official_telephone_number": "918-485-5514"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "OK",
            "license": "2298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200100890B",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PROVIDER NUMBER FOR PHYSICIAN BILLING",
            "identifier": "200100890A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CLINIC PROVIDER NUMBER",
            "identifier": "300522264",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wagoner, OK

Sources for this page

Verify at the official NPI Registry.