Northeastern Health System
Organization Active NPI Emergency Medicine Physician · Tahlequah, OK
NPI 1457574170 · NPPES record last updated May 13, 2026
Key facts
- NPI
- 1457574170
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 2178 (OK)
- Legal business name
- NORTHEASTERN HEALTH SYSTEM
- Practice address
- 1400 E Downing St
Tahlequah, OK 74464-3324 - Phone
- (918) 456-0641
- Fax
- (918) 453-2341
- NPI assigned
- Apr 11, 2007
- Organization subpart
- No
Authorized official
- Name
- James Berry
- Title
- Ceo
- Phone
- (918) 456-0641
Owned or controlled facilities with NPI records 6
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 7
Practitioners 161
-
Muneeza Afif, MD
-
Saed Fathi Awadallah, M.D.
-
Bilal Aziz, MD
-
Nathan Barney, D.O.
-
Celeste Lynn Bidwell, APRN
-
Kimyatta Brent, CRNA
-
Jamin Brown, DO
-
John Michael Carlson, D.O.
-
Jennifer Leigh Carter, NP-C
-
Jack W. Casas, M.D.
-
Saqib Chaudhry, MD
-
Donald M Elgin, MD
-
Gary Fennema, D.O.
-
Jared Michael Fink, CRNA
-
Wayne Joseph Gartner, CRNA
-
Shawn Hall, FNP
-
Carla Renee Hayes, ARNP-CNP
-
James Murphy Herrington, D.O.
-
Shane Brody Hnatusko, MSIV
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Tahlequah City Hospital |
Hospital | Operational/Managerial Control | May 1, 2008 |
| Tahlequah City Hospital |
Hospital | Operational/Managerial Control | Oct 1, 2002 |
| Tahlequah City Hospital |
Hospital | Operational/Managerial Control | Jan 1, 1974 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031125000250 | OK | Part B Supplier - Clinic/Group Practice | 1456255025 |
Receives reassigned benefits from 159 practitioners 5 other NPIs on this enrollment Practice locations: Tahlequah, OK; Sallisaw, OK |
National Provider Directory
Locations
1500 E Downing St
Ste 201
Tahlequah, OK 74464
Phone (918) 772-3390
1400 E Downing St
Ste 100
Tahlequah, OK 74464
1400 E Downing St
#2300
Tahlequah, OK 74464
1400 E Downing St
Ste 1
Tahlequah, OK 74464
1400 E Downing St
Ste 110
Tahlequah, OK 74464
Phone (918) 456-7602
4157 S Harvard Ave
Tulsa, OK 74135
Phone (918) 392-7878
774 W 9TH St
Tulsa, OK 74127
85 Ih 10 N
Beaumont, TX 77707
Phone (409) 839-8233
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | 2178 | OK | Yes |
Addresses
Primary practice location
1400 E Downing St
Tahlequah, OK 74464-3324
Mailing address
1400 E Downing St
Tahlequah, OK 74464-3324
Phone (918) 456-0641
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100700680D | Medicaid | OK |
Other names
- TAHLEQUAH HOSPITAL AUTHORITY
Other providers in Tahlequah, OK
- Northeastern Foot Care PLLC
- Northeastern Health System
- Northeastern Health System
- Northeastern Health System
- Northeastern Health System
- Northeastern Health System
- Northeastern Health System
- Northeastern Health System
- Northeastern Health System
- Northeastern Oklahoma Community Health Centers Inc
All providers in Tahlequah, OK · Emergency Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.