NPIMap

Organization Active NPI

Jane Phillips Memorial Medical Center, Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Bartlesville, OK
National Provider Identifier
1427428986
Registry record updated Sep 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
2190 Issued in OK
Legal business name
JANE PHILLIPS MEMORIAL MEDICAL CENTER, INC.
Practice address
3500 E Frank Phillips Blvd
Bartlesville, OK 74006-2411
Phone
(918) 333-7200
Fax
(918) 331-1447
NPI assigned
Sep 28, 2015
Last updated
Sep 28, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2015

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

Authorized official

Name
Michael Allen Moore
Title
Coo
Phone
(918) 331-1644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 2190 OK Primary

Addresses

Primary practice location

3500 E Frank Phillips Blvd
Bartlesville, OK 74006-2411

Mailing address

3500 E Frank Phillips Blvd
Bartlesville, OK 74006-2411
Phone (918) 333-7200

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041112000148 OK Part A Provider - Hospital 0547170888 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bartlesville, OK
O20160517000455 OK Part A Provider - Hospital 0547170888 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bartlesville, OK

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1427428986. Details of each certification follow.

Hospital certification: CCN 370018

Legal name
JANE PHILLIPS MEMORIAL MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 2, 2023
Beds
133
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 2, 1950 in OK
Enrollment address
3500 E Frank Phillips Blvd
Bartlesville, OK 74006-2411
Hospital subgroups
General, Acute care, Swing-bed approved, Psychiatric unit, Rehabilitation unit

Hospital certification: CCN 37U018

Legal name
JANE PHILLIPS MEMORIAL MEDICAL CENTER INC
Organization structure
CorporationNon-profit
Incorporated
Feb 23, 1996 in OK
Enrollment address
3500 E Frank Phillips Blvd
Bartlesville, OK 74006-2411
Hospital Swing-Bed Unit
Hospital subgroups
General, Acute care, Swing-bed approved

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Ascension St John Jane PhillipsCCN 370018 · All quality measures
Overall star rating
3 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
Jane Phillips Memorial3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

800 W Laurel St
#2
Independence, KS 67301
Phone (620) 330-8282

2661 SE Washington Blvd
#100
Bartlesville, OK 74006
Phone (918) 331-3020

2661 SE Washington Blvd
#200
Bartlesville, OK 74006
Phone (918) 331-3026

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Tanner Holt Individual Corporate OfficerCeo Oct 1, 2025 10%
Brad Rector Individual Operational/Managerial ControlBoard Member Jul 1, 2020 10%
St John Health Systems Inc Organization, Tulsa, OK Chain home office 5% Or Greater Direct Ownership Interest Oct 1, 2010 100%
Bert Walthall Individual Operational/Managerial ControlBoard Member Jul 1, 2020 10%
Paul Atkisson Individual Operational/Managerial ControlBoard Member Jan 1, 2023 10%
Stephen Colaw Individual Operational/Managerial ControlBoard Member Jan 1, 2024 10%
Paul McQuillen Individual Operational/Managerial ControlBoard Member Jan 1, 2023 10%
Tammie Strobel Individual Operational/Managerial ControlBoard Member Jan 1, 2024 10%
Anderson Mehrle Individual Operational/Managerial ControlBoard Member Jan 1, 2024 10%
Corporate DirectorBoard Member Jan 1, 2024 10%
Jane Phillips Memorial Medical Center Inc Organization, Bartlesville, OK Non-profit 5% Or Greater Direct Ownership Interest Feb 23, 1996 100%

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Affiliated clinicians 425

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

View all 425

NPI Registry JSON

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

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443398400000",
    "number": "1427428986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 E FRANK PHILLIPS BLVD",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740062411",
            "telephone_number": "918-333-7200",
            "fax_number": "918-331-1447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 E FRANK PHILLIPS BLVD",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740062411",
            "telephone_number": "918-333-7200",
            "fax_number": "918-331-1447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JANE PHILLIPS MEMORIAL MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-28",
        "last_updated": "2015-09-28",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "918-331-1644"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "OK",
            "license": "2190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartlesville, OK

Sources for this page

Verify at the official NPI Registry.