NPIMap

Organization Active NPI

Northeastern Health System

  • Emergency Medicine Physician
  • Tahlequah, OK
National Provider Identifier
1457574170
Registry record updated May 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2178 Issued in 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
Last updated
May 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2026

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

Authorized official

Name
James Berry
Title
Ceo
Phone
(918) 456-0641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2178 OK Primary

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 1

IdentifierTypeStateIssuer
100700680DMedicaidOK

Other names 1

  • TAHLEQUAH HOSPITAL AUTHORITY Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Locations

1400 E Downing St
Ste 1
Tahlequah, OK 74464

1400 E Downing St
Ste 100
Tahlequah, OK 74464

1400 E Downing St
Ste 110
Tahlequah, OK 74464
Phone (918) 456-7602

1500 E Downing St
Ste 201
Tahlequah, OK 74464
Phone (918) 772-3390

4157 S Harvard Ave
Tulsa, OK 74135
Phone (918) 712-7868

774 W 9TH St
Tulsa, OK 74127

7912 E 31st Ct
Tulsa, OK 74145
Phone (918) 728-7654

85 Ih 10 N
Beaumont, TX 77707
Phone (409) 839-8233

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tahlequah City HospitalTahlequah, OK, CCN 370089 Hospital Operational/Managerial Control May 1, 2008
Tahlequah City HospitalTahlequah, OK, CCN 37S089 Hospital Operational/Managerial Control Oct 1, 2002
Tahlequah City HospitalTahlequah, OK, CCN 37T089 Hospital Operational/Managerial Control Jan 1, 1974

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 161

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 161

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778630400000",
    "number": "1457574170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E DOWNING ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643324",
            "telephone_number": "918-456-0641",
            "fax_number": "918-453-2341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E DOWNING ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643324",
            "telephone_number": "918-456-0641",
            "fax_number": "918-453-2341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-456-0641"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "2178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100700680D",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TAHLEQUAH HOSPITAL AUTHORITY",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Tahlequah, OK

Sources for this page

Verify at the official NPI Registry.