NPIMap

Organization Active NPI

Mercy Hospital Healdton, Inc.

  • Rural Health Clinic/Center
  • Healdton, OK
National Provider Identifier
1437467388
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY HOSPITAL HEALDTON, INC.
Doing business as
Mercy Hospital Healdton Inc
Practice address
3472 Hospital Rd
Healdton, OK 73438-6124
Phone
(580) 229-0079
Fax
(580) 229-9982
NPI assigned
Sep 14, 2010
Last updated
Sep 23, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MERCY HOSPITAL HEALDTON, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Authorized official

Name
Sherry Lynn Clouse Day
Title
VP Finance
Phone
(417) 820-8439

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

3472 Hospital Rd
Healdton, OK 73438-6124

Mailing address

3462 Hospital Rd
Healdton, OK 73438-6124
Phone (417) 820-7133

Other names 1

  • Mercy Hospital Healdton Inc Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090205000358 OK Part B Supplier - Clinic/Group Practice 3375610447 Receives reassigned benefits from 57 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Healdton, OK
O20101006000661 OK Part A Provider - Rural Health Clinic 3375610447 Practice locations: Healdton, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437467388. Details of each certification follow.

Rural health clinic certification: CCN 373472

Legal name
MERCY HOSPITAL HEALDTON INC
Doing business as
MERCY HOSPITAL HEALDTON - PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 18, 2013
Last certification
Nov 12, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 31, 2008 in OK
Enrollment address
3472 Hospital Rd
Healdton, OK 73438-6124
Related CCNs
371310

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

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

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
37D2009933Mercy Hospital Healdton Primary Care3472 Hospital Road, Healdton, OK 73438Certificate of waiverJul 15, 2028

National Provider Directory

National Provider Directory
Tax ID family
Mercy Hospital Healdton Inc3 organizations share this tax ID, including this one
Part of
Mercy Hospital Healdton Inc

Other organizations with this tax ID 2

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Cheryl L Matejka Individual Operational/Managerial ControlSVP-Cfo Jul 1, 2021
Yogya Regmi Individual W-2 Managing Employee Aug 29, 2022
Jonathan Lofton Individual Corporate Director Jan 1, 2016
Rebecca Ann Hendricks Individual Corporate Director Jul 1, 2013
Christie Eckhardt Individual Corporate OfficerSecretary Jul 1, 2021
Mercy Health Organization, Chesterfield, MO Corporation, Non-profit Operational/Managerial Control Jul 15, 2010 100%
Mercy Health Oklahoma Communities Organization, Oklahoma City, OK Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jul 2, 2013 100%
Darlye Voss Individual Corporate OfficerPresident Jul 1, 2021
Lindsay a Wilson Individual Corporate DirectorBoard Member Jul 1, 2022
Mercy Hospital Ardmore Inc Organization, Ardmore, OK Non-profit 5% Or Greater Direct Ownership Interest Jul 14, 2010
Sherry Clouse Day Individual Corporate OfficerTreasurer Jan 1, 2021
W-2 Managing EmployeeVP of Finance-Cah Jan 1, 2021
Joy Linn Alexander Individual Corporate DirectorBoard Member Jan 1, 2016

Owners & managing parties with NPI records 5

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

Facilities with the same owner 119

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 119

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1284422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632355200000",
    "number": "1437467388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3462 HOSPITAL RD",
            "city": "HEALDTON",
            "state": "OK",
            "postal_code": "734386124",
            "telephone_number": "417-820-7133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3472 HOSPITAL RD",
            "city": "HEALDTON",
            "state": "OK",
            "postal_code": "734386124",
            "telephone_number": "580-229-0079",
            "fax_number": "580-229-9982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL HEALDTON, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY HOSPITAL HEALDTON, INC",
        "enumeration_date": "2010-09-14",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A",
        "authorized_official_last_name": "CLOUSE DAY",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "417-820-8439"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Hospital Healdton Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Healdton, OK

Sources for this page

Verify at the official NPI Registry.