NPIMap

Organization Active NPI

Iacc/Ehi NW, LLC

Doing business as INTEGRIS Community Hospital - Moore

  • General Acute Care Hospital
  • Moore, OK
National Provider Identifier
1447734272
Registry record updated Sep 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
IACC/EHI NW, LLC
Doing business as
INTEGRIS Community Hospital - Moore
Practice address
1401 SW 34TH St
Moore, OK 73160-3059
Phone
(405) 500-3330
Fax
(405) 793-1315
NPI assigned
Sep 18, 2018
Last updated
Sep 10, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2019

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

Authorized official

Name
John Buck, MD
Title
Secretary
Phone
(713) 637-1004

Specialties & licenses 1

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

Addresses

Primary practice location

1401 SW 34TH St
Moore, OK 73160-3059

Mailing address

8686 New Trails Dr Ste 100
The Woodlands, TX 77381-1176
Phone (713) 637-1146

Other identifiers 3

IdentifierTypeStateIssuer
200834400DMedicaidOK
2388OtherOKHOSPITAL LICENSE
370240OtherOKMEDICARE

Other names 1

  • INTEGRIS Community Hospital - Moore Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190625000751 OK Part A Provider - Hospital 3072859545 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Del City, OK; Moore, OK; Oklahoma City, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447734272. Details of each certification follow.

Hospital certification: CCN 370240

Legal name
IACC/EHI NW, LLC
Doing business as
INTEGRIS COMMUNITY HOSPITAL -COUNCIL CROSSING
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
May 31, 2019
Last certification
Mar 27, 2025
Beds
32
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Jul 3, 2017 in OK
Enrollment address
9417 N Council Rd
Oklahoma City, OK 73162-6228
Main/Primary Hospital Location
Hospital subgroups
Acute care

Other NPIs on the same Medicare enrollment 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Integris Community Hospital - Council CrossingCCN 370240 · All quality measures
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

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
37D2159641Integris Community Hospital - Moore1401 SW 34TH Street, Moore, OK 73160AccreditationSep 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Iaccehi NW LLC4 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.

  • Iacc/Ehi NW, LLC

    dba Integris Community Hospital-Council Crossing

    • General Acute Care Hospital
    • Oklahoma City, OK
    • NPI 1194209155
    NPD tax ID
  • Iacc/Ehi NW, LLC

    dba INTEGRIS Community Hospital - OKC West

    • General Acute Care Hospital
    • Oklahoma City, OK
    • NPI 1336623198
    NPD tax ID
  • Iacc/Ehi NW, LLC

    dba INTEGRIS Community Hospital - Del City

    • General Acute Care Hospital
    • Del City, OK
    • NPI 1942784715
    NPD tax ID

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Homer D Kirby Individual 5% Or Greater Indirect Ownership Interest Jul 3, 2017 8.51%
Vanessa Smith Individual Corporate OfficerPresident Jul 21, 2022
W-2 Managing EmployeePresident Jul 21, 2022
Emerus Group Holdings LP Organization, New York, NY Holding company 5% Or Greater Indirect Ownership Interest Jul 3, 2017 49%
David Maxwell Individual OtherBoard Member Jul 21, 2022
Integris Emergency Hopsitals LLC Organization, The Woodlands, TX For-profit 5% Or Greater Direct Ownership Interest Jul 3, 2017 100%
Integris Ambulatory Care Corporation Organization, Oklahoma City, OK For-profit 5% Or Greater Direct Ownership Interest Feb 6, 2019 51%
Emerus Intermediate Holdings Inc Organization, New York, NY Corporation, Holding company 5% Or Greater Indirect Ownership Interest Jul 3, 2017 49%
Toby R Hamilton Individual 5% Or Greater Indirect Ownership Interest Jul 3, 2017 10.87%
Jaba Interest LLC Organization, The Woodlands, TX LLC 5% Or Greater Indirect Ownership Interest Jul 3, 2017 10.55%
Carolyn Young Individual Corporate OfficerSecretary Jul 21, 2022
W-2 Managing EmployeeBoard Member Jul 21, 2022
Emerus Investment Company VIII LLC Organization, The Woodlands, TX LLC, For-profit 5% Or Greater Indirect Ownership Interest Jul 3, 2017 49%
Emerus Holdings, Inc. Organization, The Woodlands, TX Corporation 5% Or Greater Indirect Ownership Interest Jul 3, 2017 49%
Welsh Carson Anderson & Stowe XII, LP Organization, New York, NY 5% Or Greater Indirect Ownership Interest Jul 3, 2017 33.93%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 19

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 19

Affiliated clinicians 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1537228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568073600000",
    "number": "1447734272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8686 NEW TRAILS DR STE 100",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773811176",
            "telephone_number": "713-637-1146",
            "fax_number": "281-465-8414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 SW 34TH ST",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731603059",
            "telephone_number": "405-500-3330",
            "fax_number": "405-793-1315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IACC/EHI NW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-18",
        "last_updated": "2019-09-10",
        "status": "A",
        "authorized_official_last_name": "BUCK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "713-637-1004",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200834400D",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOSPITAL LICENSE",
            "identifier": "2388",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "370240",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INTEGRIS Community Hospital - Moore",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "INTEGRIS Community Hospital - Moore",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moore, OK

Sources for this page

Verify at the official NPI Registry.