Clinico LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

CLINICO LLC

Doing business as

Clinico Rural Health Clinic

Practice address

103 E Main
Beggs, OK 74421-0478

Phone

(918) 267-7000

Fax

(918) 267-7077

NPI assigned

Aug 10, 2006

Last updated

Sep 30, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kerri Lee Ellis, FNP-CNPI 1447409206

Title

Owner/Administrator

Phone

(918) 367-0010

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Clinico Rural Health Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in OK2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497766000. Details of each certification follow.

• CCN 373868 Rural health clinic · Active · Details

Rural health clinic certification: CCN 373868

Legal name

CLINICO LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Feb 5, 2002

Last certification

May 24, 2016

Ownership / control type

1B

Organization structure

LLCProprietary

Incorporated

Oct 25, 2001 in OK

Enrollment address

103 E Main
Beggs, OK 74421-0478

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 3

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

Owners & managing parties with NPI records 1

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

• Kerri Lee Ellis, A.R.N.P.

  • Family Nurse Practitioner
  • Beggs, OK
  • NPI 1447409206

  5% Or Greater Direct Ownership Interest, Corporate Director

  CMS ownership

Practitioners 2

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.

• Kerri Lee Ellis, A.R.N.P.

  • Family Nurse Practitioner
  • Beggs, OK
  • NPI 1447409206
  Medicare reassignment NPD Authorized official
• Monica Ann Kirkendoll, ARNP

  • Family Nurse Practitioner
  • Tulsa, OK
  • NPI 1750821658
  NPD (past)

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632960000000",
    "number": "1497766000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 478",
            "city": "BEGGS",
            "state": "OK",
            "postal_code": "744210478",
            "telephone_number": "918-267-7000",
            "fax_number": "918-267-7077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 E MAIN",
            "city": "BEGGS",
            "state": "OK",
            "postal_code": "744210478",
            "telephone_number": "918-267-7000",
            "fax_number": "918-267-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "KERRI",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "918-367-0010",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100708410B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinico Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinico Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Rural Health Clinic/Center in Beggs, OK
• Providers in Beggs, OK by specialty
• Rural Health Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.