NPIMap

Organization Active NPI

Northeastern Oklahoma Community Health Centers Inc

Doing business as Hulbert Health Center

  • Federally Qualified Health Center (FQHC)
  • Hulbert, OK
National Provider Identifier
1518070481
Registry record updated Jun 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
0612740 Issued in OK
Legal business name
NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS INC
Doing business as
Hulbert Health Center
Practice address
124 E Main St
Hulbert, OK 74441-8902
Phone
(918) 772-2879
Fax
(918) 772-1233
NPI assigned
Aug 16, 2006
Last updated
Jun 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2020

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

Authorized official

Name
Scott Rosenthal
Title
Ceo
Phone
(918) 772-3390

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 0612740 OK Primary

Addresses

Primary practice location

124 E Main St
Hulbert, OK 74441-8902

Mailing address

PO Box 751
Hulbert, OK 74441-0751
Phone (918) 772-3390

Other identifiers 4

IdentifierTypeStateIssuer
200006960EMedicaidOK
200006960HMedicaidOK
200006960AMedicaidOK
200006960IMedicaidOK

Other names 1

  • Hulbert Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20030409000016 OK Part A Provider - Federally Qualified Health Center (FQHC) 3678482635 Practice locations: Hulbert, OK
O20031104000417 OK Part B Supplier - Clinic/Group Practice 3678482635 Receives reassigned benefits from 70 practitioners
14 other NPIs on this enrollment
Practice locations: Westville, OK; Tahlequah, OK; Salina, OK; Pryor, OK; Muskogee, OK; Hulbert, OK
O20130511000090 OK Part A Provider - Federally Qualified Health Center (FQHC) 3678482635 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Muskogee, OK

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1518070481. Details of each certification follow.

Federally qualified health center certification: CCN 371833

Legal name
NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 8, 2003
Last certification
May 8, 2003
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Dec 3, 2001 in OK
Enrollment address
124 E Main St
Hulbert, OK 74441-8902

Federally qualified health center certification: CCN 371887

Legal name
NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 28, 2013
Last certification
Mar 28, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 3, 2001 in OK
Enrollment address
922 N York St
Muskogee, OK 74403-3137

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 13

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

View all 13

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
37D2066673Hulbert Health Center124 E Main Street, Hulbert, OK 74441Certificate of waiverSep 30, 2027

National Provider Directory

National Provider Directory

Locations

101 E Ferry St
Salina, OK 74365
Phone (918) 434-7440

1500 E Downing St
Ste 103
Tahlequah, OK 74464
Phone (918) 456-0001

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Luann Hudson Individual Corporate OfficerBoard Member Jun 19, 2019 10%
Corporate OfficerBoard Member Jun 19, 2019
Joann Bradley Individual Corporate OfficerBoard Member Dec 1, 2011 10%
Corporate DirectorBoard Member Dec 20, 2011
Scott Rosenthal Individual Corporate OfficerCeo Dec 1, 2012 100%
Operational/Managerial ControlCeo Dec 1, 2012 100%
Corporate DirectorCeo Dec 1, 2012
Operational/Managerial ControlCeo Nov 1, 2013
Joan Foster Individual Corporate OfficerBoard Member Jan 1, 2011 10%
Corporate DirectorBoard Member Mar 21, 2009
Courtney Hamby Individual Corporate OfficerBoard Member Apr 1, 2015 10%
Corporate OfficerBoard Member Jun 1, 2016
Timothy M Booth Individual Corporate OfficerBoard Member Sep 1, 2012 10%
Corporate DirectorBoard Member Nov 18, 2012
Josh Stafford Individual Corporate OfficerBoard Member Dec 1, 2014 10%
Corporate OfficerBoard Member Dec 1, 2014
Crystal Steed Individual Operational/Managerial ControlCoo Dec 1, 2012
Corporate OfficerCoo Dec 1, 2012 100%
W-2 Managing Employee Mar 21, 2013
Operational/Managerial ControlCoo Dec 1, 2012 100%
Beverly Runnels Individual Corporate OfficerBoard Member Dec 1, 2011 10%
Corporate OfficerBoard Secretary Sep 27, 2011
Anthony Ward Individual Corporate OfficerBoard Member Dec 27, 2018 10%
Corporate OfficerBoard Member Dec 27, 2018
Trena Payton Individual Corporate OfficerBoard Member Jul 28, 2016 10%
Corporate OfficerBoard Member Jul 28, 2016

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Neohealth Tahlequah Health CenterTahlequah, OK, CCN 371867 Federally qualified health center Operational/Managerial Control Jan 1, 2011
Neohealth OB/GYNTahlequah, OK, CCN 371868 Federally qualified health center Operational/Managerial Control Jan 1, 2011
Neohealth Westville Family Medical CenterWestville, OK, CCN 371869 Federally qualified health center Operational/Managerial Control Sep 1, 2010
Neohealth Tahlequah Primary CareTahlequah, OK, CCN 371967 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2012
Pryor Family Medical CenterPryor, OK, CCN 371980 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2012

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 70

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 70

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591660800000",
    "number": "1518070481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751",
            "city": "HULBERT",
            "state": "OK",
            "postal_code": "744410751",
            "telephone_number": "918-772-3390",
            "fax_number": "918-772-2244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 E MAIN ST",
            "city": "HULBERT",
            "state": "OK",
            "postal_code": "744418902",
            "telephone_number": "918-772-2879",
            "fax_number": "918-772-1233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2020-06-09",
        "certification_date": "2020-06-09",
        "status": "A",
        "authorized_official_last_name": "ROSENTHAL",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-772-3390"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "OK",
            "license": "0612740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200006960E",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200006960H",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200006960A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200006960I",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hulbert Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hulbert Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hulbert, OK

Sources for this page

Verify at the official NPI Registry.