NPIMap

Organization Active NPI

Integris Miami Hospital

Doing business as INTEGRIS Hospice Northeast

  • Community Based Hospice Care Agency
  • Miami, OK
National Provider Identifier
1457368342
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
INTEGRIS MIAMI HOSPITAL
Doing business as
INTEGRIS Hospice Northeast
Practice address
207 2ND Ave SW
Miami, OK 74354-6818
Phone
(918) 542-1226
NPI assigned
Aug 2, 2006
Last updated
Sep 30, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
INTEGRIS MIAMI HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Authorized official

Name
Donna Wallace
Title
Assistant Treasurer
Phone
(636) 359-4890

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

207 2ND Ave SW
Miami, OK 74354-6818

Mailing address

PO Box 200759
Dallas, TX 75320-0759
Phone (405) 252-8400

Other names 1

  • INTEGRIS Hospice Northeast Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080527000638 OK Part A Provider - Hospice 1254235468 Practice locations: Miami, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457368342. Details of each certification follow.

Hospice certification: CCN 371586

Legal name
INTEGRIS MIAMI HOSPITAL
Doing business as
INTEGRIS HOSPICE NORTHEAST
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 13, 2000
Last certification
Sep 8, 2020
Ownership / control type
Proprietary - Corporation
Organization structure
LLCNon-profit
Incorporated
Feb 1, 1994 in OK
Enrollment address
207 2ND Ave SW
Miami, OK 74354-6818

Other NPIs with the same Medicare PAC ID 5

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Integris Hospice NortheastCCN 371586 · All quality measures
Ownership
For-Profit
Certified
Apr 13, 2000
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Alliance Private Duty5 organizations share this tax ID, including this one
Part of
Alliance Private Duty

Other organizations with this tax ID 4

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

Locations

115 S Main St
Miami, OK 74354
Phone (918) 542-1226

Ownership & 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.

NameRoleSinceShare
James D Rutter Individual Corporate Director Jul 1, 2016
John Hampton Individual Corporate Director May 1, 2019
Donna M Wallace Individual Corporate OfficerAssistant Treasurer Oct 27, 2023
Rayetta L Dominguez Individual Contracted Managing EmployeeAd; Dec 13, 1999
Operational/Managerial ControlAdministrator Dec 13, 1999
Michael L Weed Individual Corporate OfficerTreasurer Jan 1, 2023
Casey Ahlden Individual Corporate Officer Jan 1, 2023
Charles a Neal Individual Corporate Director Jun 30, 2005
Integris Health Inc Organization, Oklahoma City, OK Corporation, Non-profit, Chain home office Operational/Managerial Control Jul 1, 1994
Brent Hubbard Individual Corporate Officer Jul 1, 2022
Corporate Director Jul 1, 2022
Dustin a Thompson Individual Contracted Managing EmployeeMD; Nov 1, 2022
Operational/Managerial ControlMedical Director Nov 1, 2022
Justin Lee Mitchell Individual Corporate Officer Dec 1, 2019
James Perryman Individual Corporate Officer Jul 1, 2024
Corporate Director Jul 1, 2017
Jonas Rabel Individual Contracted Managing EmployeeChief Hospital Executive May 1, 2017
Corporate OfficerChief Hospital Executive May 1, 2017
Operational/Managerial ControlChief Hospital Executive May 1, 2017
Baptist Healthcare of Oklahoma LLC Organization, Oklahoma City, OK LLC, Non-profit Operational/Managerial Control Jun 7, 1978
Rene Galan Individual Corporate Officer Jul 1, 2024
Corporate Director Jul 1, 2024
Caleb Goldner Individual Corporate Director Jan 1, 2015
Bradford J Stephens Individual Contracted Managing EmployeeMD; Apr 9, 2012
Operational/Managerial ControlMedical Director Apr 9, 2012
Grant Kernan Individual Corporate Officer Jul 1, 2023
Corporate Director Jan 1, 2015
David R Frazier Individual Corporate Officer Jul 1, 2024
Corporate Director Nov 1, 2017
Patrick Jurgensmeyer Individual Corporate Director Jun 28, 2005

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 31

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

View all 31

Practitioners & affiliated clinicians

Affiliated clinicians 6

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": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727654400000",
    "number": "1457368342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 200759",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753200759",
            "telephone_number": "405-252-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 2ND AVE SW",
            "city": "MIAMI",
            "state": "OK",
            "postal_code": "743546818",
            "telephone_number": "918-542-1226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRIS MIAMI HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTEGRIS MIAMI HOSPITAL",
        "enumeration_date": "2006-08-02",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "ASSISTANT TREASURER",
        "authorized_official_telephone_number": "636-359-4890"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INTEGRIS Hospice Northeast",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Miami, OK

Sources for this page

Verify at the official NPI Registry.