Active NPI
Baptist Healthcare of Oklahoma, LLC
Doing business as Integris Home Care Northeast
- Home Health Agency
- Grove, OK
National Provider Identifier
1407860190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 7012
- Legal business name
- BAPTIST HEALTHCARE OF OKLAHOMA, LLC
- Doing business as
- Integris Home Care Northeast
- Practice address
- 1103 E 13TH St
Suite D
Grove, OK 74344-7928 - Phone
- (918) 786-4461
- Fax
- (918) 787-3645
- NPI assigned
- Jul 28, 2006
- Last updated
- Jun 3, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Brent Davis
- Title
- Vice President
- Phone
- (405) 949-3774
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 7012 | OK | Primary |
Addresses
Primary practice location
1103 E 13TH St
Suite D
Grove, OK 74344-7928
Mailing address
PO Box 960399
Oklahoma City, OK 73196-0399
Phone (918) 786-4461
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100699700E | Medicaid | OK |
Other names 1
- Integris Home Care Northeast
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080527000640 | OK | Part A Provider - Home Health Agency | 1254235468 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Miami, OK |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1407860190. Details of each certification follow.
Home health agency certification: CCN 377050
- Legal name
- INTEGRIS MIAMI HOSPITAL
- Doing business as
- INTEGRIS HOME CARE NORTHEAST
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jan 6, 1984
- Last certification
- Nov 27, 2018
- Ownership / control type
- Non-Profit
- Organization structure
- LLC
- Enrollment address
- 207 2ND Ave SW
Miami, OK 74354-6818
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Integris Home Care Northeast
- Home Health Agency
- Miami, OK
- NPI 1194748319
O20080527000640
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Integris Home Care Northeast
- Overall star rating
- Ownership
- Non-Profit
- Certified
- Jan 6, 1984
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider DirectoryOwnership & 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.
| Name | Role | Since | Share |
|---|---|---|---|
| James D Rutter | Corporate Director | Jul 1, 2016 | |
| John Hampton | Corporate Director | May 1, 2019 | |
| Donna M Wallace | Corporate Officer | Oct 27, 2023 | |
| Rayetta L Dominguez | Contracted Managing Employee | Dec 13, 1999 | |
| Operational/Managerial Control | Dec 13, 1999 | ||
| Michael L Weed | Corporate Officer | Jan 1, 2023 | |
| Casey Ahlden | Corporate Officer | Jan 1, 2023 | |
| Charles a Neal | Corporate Director | Jun 30, 2005 | |
| Integris Health Inc | Operational/Managerial Control | Jul 1, 1994 | |
| Brent Hubbard | Corporate Officer | Jul 1, 2022 | |
| Corporate Director | Jul 1, 2022 | ||
| Justin Lee Mitchell | Corporate Officer | Dec 1, 2019 | |
| James Perryman | Corporate Officer | Jul 1, 2024 | |
| Corporate Director | Jul 1, 2017 | ||
| Jonas Rabel | Contracted Managing Employee | May 1, 2017 | |
| Corporate Officer | May 1, 2017 | ||
| Operational/Managerial Control | May 1, 2017 | ||
| Baptist Healthcare of Oklahoma LLC | Operational/Managerial Control | Jun 7, 1978 | |
| Rene Galan | Corporate Officer | Jul 1, 2024 | |
| Corporate Director | Jul 1, 2024 | ||
| Caleb Goldner | Corporate Director | Jan 1, 2015 | |
| Grant Kernan | Corporate Officer | Jul 1, 2023 | |
| Corporate Director | Jan 1, 2015 | ||
| David R Frazier | Corporate Officer | Jul 1, 2024 | |
| Corporate Director | Nov 1, 2017 | ||
| Integris Rural Health Inc | Operational/Managerial Control | Jul 1, 1994 | |
| Patrick Jurgensmeyer | Corporate Director | Jun 28, 2005 | |
| Timothy Pehrson | Other | Aug 1, 2018 |
Owners & managing parties with NPI records 3
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Obstetrics & Gynecology Physician
- Miami, OK
- NPI 1881804029
Corporate Director, Corporate Officer
Practitioners & affiliated clinicians
Affiliated clinicians 19
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1591142400000",
"number": "1407860190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 960399",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731960399",
"telephone_number": "918-786-4461",
"fax_number": "918-787-3645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1103 E 13TH ST",
"address_2": "SUITE D",
"city": "GROVE",
"state": "OK",
"postal_code": "743447928",
"telephone_number": "918-786-4461",
"fax_number": "918-787-3645"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BAPTIST HEALTHCARE OF OKLAHOMA, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-28",
"last_updated": "2020-06-03",
"certification_date": "2020-06-03",
"status": "A",
"authorized_official_last_name": "DAVIS",
"authorized_official_first_name": "BRENT",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "405-949-3774"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "OK",
"license": "7012",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100699700E",
"state": "OK"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Integris Home Care Northeast",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Grove, OK
- Lisa Meshelle Autry
- Aviation Medicine of Oklahoma
- Danielle Cherish Ballou-Allsup, D.C.
- Ban NH, LLC (Betty Ann Nursing Center)
- Baptist Healthcare of Oklahoma (Integris Grove General Hospital ER Physicians)
- Jessica Barbour
- Lisa M Barlow, PHARM D
- Adam Tyler Barnes, DDS
- Ramie Lehelen Hazel Barnes, O.D.
- Elizabeth N Barth, BC-HIS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.