St. John Broken Arrow, Inc
Organization Active NPI General Acute Care Hospital · Broken Arrow, OK
NPI 1497988596 · NPPES record last updated Oct 2, 2024
Key facts
- NPI
- 1497988596
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 2380 (OK)
- Legal business name
- ST. JOHN BROKEN ARROW, INC
- Practice address
- 1000 W Boise Cir
Broken Arrow, OK 74012-4900 - Phone
- (918) 994-8100
- Fax
- (918) 994-8199
- NPI assigned
- Aug 24, 2009
- Organization subpart
- Yes
- Parent organization (as reported)
- ST. JOHN HEALTH SYSTEM, INC.
Authorized official
- Name
- Matt Adams
- Title
- Ceo
- Phone
- (918) 994-8100
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 1
-
Joshua Z Vicena, D.O.
Facilities with the same owner 7
Practitioners 73
-
Anthony Barbettini, PA-C
-
Patrick Paul Branagan, D.P.M.
-
Mindi Marie Bull, D.O.
-
Caleb Eugene Burrows, D.O.
-
Brian A. Chalkin, DO
-
Chance Dodson, MD
-
Kip Weston Dorsey, M.D.
-
Kiamars Golmoradi, DO, MBA
-
Chad Hanson, D.O.
-
James Hensel, D.O.
-
Gregory R Holt, MD
-
Joe D Huddleston, DO
-
Lynne H Imhoff, M.D.
-
Scott A Keller, MD
-
Shon D. Kendall, D.O.
-
Lindsey King, MD
-
Changxing Liu, MD
-
Luke Earl Matloff, D.O.
-
Shawn E. Minor, D.O.
-
Yogesh Mittal, MD
-
Lisa S Mogelnicki, DPM
Affiliated clinicians 328
-
Pallavi Agarwal, M.D.
-
Kasra Ahmadinia, M.D
-
Justin Troy Albright, DPM
-
Taylor Owens Ampleford, DNP-A, CRNA
-
Hannah Lea Apple, PA-C
-
Kristen Nichole Ball, PA-C
-
Anthony Barbettini, PA-C
-
Nathan Barney, D.O.
-
Renae Lyn Bateman, FNP
-
Bradley D. Beasley, DPM
-
Ashesh Bhakta, D.O.
-
Jeffrey L Bigler, M.D.
-
Patrick Paul Branagan, D.P.M.
-
William K Briggs, M.D.
-
Amy K Brookover, PA
-
Mackenzie Brubaker, CRNA
-
Patrick Cody Buchanan, D.O.
Medicare Care Compare: Hospital
- Listed as
- Ascension St John Broken Arrow
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D2004048 | Ascension St John Broken Arrow, Inc | Accreditation | Apr 11, 2027 |
| 37D2004755 | St John Broken Arrow, Inc | Certificate of waiver | Mar 10, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Hospital certification: CCN 370235
- Legal name
- ST. JOHN BROKEN ARROW, INC
- Doing business as
- ST JOHN BROKEN ARROW
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Oct 11, 2010
- Last certification
- Jul 27, 2023
- Beds
- 62
- Ownership / control type
- Private (not for profit)
- Most recent change of ownership
- Jun 1, 2012 (1 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 1, 2011 in OK
- Enrollment address
- 1000 W Boise Cir
St John Broken Arrow
Broken Arrow, OK 74012-4900 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Sheila Vancuren |
Operational/Managerial Control |
Jul 1, 2025 | 5% |
| Catherine Gebetsberger |
Corporate Director |
Jan 1, 2024 | 5% |
| Brian Mithcell |
Operational/Managerial Control |
Jul 1, 2025 | 5% |
| St John Health Systems Inc |
5% Or Greater Direct Ownership Interest | Feb 1, 2011 | 100% |
| Joshua Zachariah Vicena |
Corporate Director |
Jan 1, 2024 | 5% |
| Matthew Adams |
W-2 Managing Employee |
Jun 1, 2022 | 5% |
| Mark Lawson |
Operational/Managerial Control |
Jul 1, 2025 | 5% |
| Lisa Ford |
Operational/Managerial Control |
Jul 1, 2025 | 5% |
| Thomas Kimball |
Operational/Managerial Control |
Jul 1, 2025 | 5% |
| Heather Turner |
Operational/Managerial Control |
Jul 1, 2025 | 5% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120501000470 | OK | Part a Provider - Hospital | 8628230018 | Practice locations: Broken Arrow, OK; Jenks, OK |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 2380 | OK | Yes |
| General Acute Care Hospital | 282N00000X |
Addresses
Primary practice location
1000 W Boise Cir
Broken Arrow, OK 74012-4900
Mailing address
1000 W Boise Cir
Broken Arrow, OK 74012-4900
Phone (918) 994-8100
Other practice location 1
3029 W Main St
Jenks, OK 74037-3465
Phone (918) 528-7800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 370235 | Other | MEDICARE CCN |
Other names
- Ascension St. John Jenks
- St. John Broken Arrow
Other providers in Broken Arrow, OK
- Sheena M Spies
- Taylor J Sprague
- Spring Dental-Broken Arrow
- Fady Srour
- St John Villas Inc
- St. John Encompass Health Rehabilitation Hospital, LLC
- St.John Villas Inc
- McKenzie Stabler
- Stacey Murrell, OD PC Inc
- Ashley Stamm
All providers in Broken Arrow, OK · General Acute Care Hospital in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2024. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.