NPIMap

Organization Active NPI

St. John Broken Arrow, Inc

Doing business as Ascension St. John Jenks

  • General Acute Care Hospital
  • Broken Arrow, OK
National Provider Identifier
1497988596
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
2380 Issued in OK
Legal business name
ST. JOHN BROKEN ARROW, INC
Doing business as
Ascension St. John Jenks
St. John Broken Arrow
Practice address
1000 W Boise Cir
Broken Arrow, OK 74012-4900
Phone
(918) 994-8100
Fax
(918) 994-8199
NPI assigned
Aug 24, 2009
Last updated
Oct 2, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. JOHN HEALTH SYSTEM, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Authorized official

Name
Matt Adams
Title
Ceo
Phone
(918) 994-8100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X
General Acute Care Hospital 282N00000X 2380 OK Primary

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 1

IdentifierTypeStateIssuer
370235OtherMEDICARE CCN

Other names 2

  • Ascension St. John Jenks Doing business as
  • St. John Broken Arrow Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120501000470 OK Part A Provider - Hospital 8628230018 Practice locations: Broken Arrow, OK; Jenks, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497988596. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Feb 1, 2011 in OK
Enrollment address
1000 W Boise Cir
St John Broken Arrow
Broken Arrow, OK 74012-4900
Main/Primary Hospital Location
Hospital subgroups
Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Ascension St John Broken ArrowCCN 370235 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D2004048Ascension St John Broken Arrow, Inc1000 W Boise Circle, Broken Arrow, OK 74012AccreditationApr 11, 2027
37D2004755St John Broken Arrow, Inc1000 West Boise Circle, Broken Arrow, OK 74012Certificate of waiverMar 10, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Sheila Vancuren Individual Operational/Managerial ControlBoard Member Jul 1, 2025 5%
Catherine Gebetsberger Individual Corporate DirectorBoard Member Jan 1, 2024 5%
Brian Mithcell Individual Operational/Managerial ControlBoard Member Jul 1, 2025 5%
St John Health Systems Inc Organization, Tulsa, OK Non-profit 5% Or Greater Direct Ownership Interest Feb 1, 2011 100%
Joshua Zachariah Vicena Individual Corporate DirectorBoard Member Jan 1, 2024 5%
Matthew Adams Individual W-2 Managing EmployeePresident Jun 1, 2022 5%
Mark Lawson Individual Operational/Managerial ControlBoard Member Jul 1, 2025 5%
Lisa Ford Individual Operational/Managerial ControlBoard Member Jul 1, 2025 5%
Thomas Kimball Individual Operational/Managerial ControlBoard Member Jul 1, 2025 5%
Heather Turner Individual Operational/Managerial ControlBoard Member Jul 1, 2025 5%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 7

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 73

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 73

Affiliated clinicians 328

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 328

NPI Registry JSON

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

{
    "created_epoch": "1251072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1497988596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 W BOISE CIR",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740124900",
            "telephone_number": "918-994-8100",
            "fax_number": "918-994-8199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W BOISE CIR",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740124900",
            "telephone_number": "918-994-8100",
            "fax_number": "918-994-8199"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3029 W Main St",
            "address_purpose": "LOCATION",
            "city": "Jenks",
            "state": "OK",
            "postal_code": "740373465",
            "country_code": "US",
            "telephone_number": "918-528-7800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. JOHN BROKEN ARROW, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. JOHN HEALTH SYSTEM, INC.",
        "enumeration_date": "2009-08-24",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-994-8100"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "OK",
            "license": "2380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CCN",
            "identifier": "370235",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension St. John Jenks",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. John Broken Arrow",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. John Broken Arrow",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broken Arrow, OK

Sources for this page

Verify at the official NPI Registry.