NPIMap

Organization Active NPI

Integris Health Ponca City Hospital Inc

Doing business as Integris Health Medical Group

  • Rural Health Clinic/Center
  • Ponca City, OK
National Provider Identifier
1528830163
Registry record updated Sep 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
INTEGRIS HEALTH PONCA CITY HOSPITAL INC
Doing business as
Integris Health Medical Group
Practice address
1908 N 14TH St
Ste 202, 203, 205 & 207
Ponca City, OK 74601-2039
Phone
(580) 718-4501
NPI assigned
Oct 26, 2023
Last updated
Sep 17, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
INTEGRIS HEALTH PONCA CITY HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 17, 2026

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

Authorized official

Name
Michael L Weed
Title
Treasurer
Phone
(405) 951-2737

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Medicine Physician 207Q00000X
Gynecology Physician 207VG0400X
Obstetrics Physician 207VX0000X
Pediatrics Physician 208000000X

Addresses

Primary practice location

1908 N 14TH St
Ste 202, 203, 205 & 207
Ponca City, OK 74601-2039

Mailing address

PO Box 840026
Kansas City, MO 64184-0026
Phone (405) 252-8400

Other names 1

  • INTEGRIS HEALTH MEDICAL GROUP Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240105000676 OK Part A Provider - Rural Health Clinic 1052762820 Practice locations: Ponca City, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1528830163. Details of each certification follow.

Rural health clinic certification: CCN 378510

Legal name
INTEGRIS HEALTH PONCA CITY HOSPITAL INC
Doing business as
INTEGRIS HEALTH MEDICAL GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 25, 2018
Last certification
May 27, 2021
Ownership / control type
2B
Most recent change of ownership
Nov 1, 2023 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Aug 16, 2023 in OK
Enrollment address
1908 N 14TH St
Ste 202, 203 & 207
Ponca City, OK 74601-2039
Related CCNs
370006

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

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
37D1065330Integris Health Ponca City Hospital1908 N 14TH St, Ste 203, Ponca City, OK 74601Certificate of waiverFeb 26, 2027
37D2183453Integris Health Medical Group1908 N 14TH, Ste 205, Ponca City, OK 74601Certificate of waiverMay 4, 2028
37D2228056Integris Health Medical Group1908 N 14TH, Ste 202, Ponca City, OK 74601Certificate of waiverJun 21, 2027
37D2229659Integris Health Medical Group1908 N 14TH, Ste 206, Ponca City, OK 74601Certificate of waiverJul 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Integris Health Ponca City Hospital Inc3 organizations share this tax ID, including this one
Part of
Integris Health Ponca City Hospital Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1908 N 14th St
Ponca City, OK 74601
Phone (580) 765-0518

1908 N 14th St
Ste 202
Ponca City, OK 74601
Phone (580) 718-4501

1908 N 14th St
Ste 202B
Ponca City, OK 74601
Phone (580) 713-4501

1908 N 14th St
Ste 203A
Ponca City, OK 74601

1908 N 14th St
Ste 207
Ponca City, OK 74601
Phone (405) 737-2486

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Donna M Wallace Individual Corporate OfficerAssistant Treasurer Oct 31, 2023
Michael L Weed Individual Contracted Managing EmployeeTreasurer Aug 16, 2023
Corporate OfficerTreasurer Oct 31, 2023
Operational/Managerial ControlTreasurer Aug 16, 2023
Integris Health Inc Organization, Oklahoma City, OK Corporation, Non-profit Operational/Managerial Control Aug 16, 2023
Brent Hubbard Individual Contracted Managing EmployeeSenior Vice President & Coo Aug 16, 2023
Corporate OfficerSenior Vice President & Coo Oct 31, 2023
Operational/Managerial ControlSenior Vice President & Coo Aug 16, 2023
Guillermo Robles Individual Contracted Managing EmployeeMedical Director Nov 1, 2023
Operational/Managerial ControlMedical Director Nov 1, 2023
Timothy Pehrson Individual Contracted Managing EmployeePresident & Ceo Aug 16, 2023
Corporate OfficerPresident & Ceo Oct 31, 2023
Corporate DirectorPresident & Ceo Aug 16, 2023
Operational/Managerial ControlPresident & Ceo Aug 16, 2023
OtherChain Home Office Administrator Nov 1, 2023
Christopher Mendoza Individual Contracted Managing EmployeeChief Hospital Executive Nov 1, 2023
Corporate OfficerChief Hospital Executive Nov 1, 2023
Operational/Managerial ControlChief Hospital Executive Nov 1, 2023
Mindy Meyer Individual Contracted Managing EmployeeDirector Physician Operations Nov 1, 2023
Operational/Managerial ControlDirector Physician Operations Nov 1, 2023

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 30

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

View all 30

Change-of-ownership history 1

DateEventCounterparty
Nov 1, 2023 Change of OwnershipThis provider was the buyer Alliancehealth Clinic Ponca CityCCN 378510, OK, NPI 1932634573

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

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 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1698278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789603200000",
    "number": "1528830163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840026",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641840026",
            "telephone_number": "405-252-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1908 N 14TH ST",
            "address_2": "STE 202, 203, 205 & 207",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746012039",
            "telephone_number": "580-718-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRIS HEALTH PONCA CITY HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTEGRIS HEALTH PONCA CITY HOSPITAL INC",
        "enumeration_date": "2023-10-26",
        "last_updated": "2026-09-17",
        "certification_date": "2026-09-17",
        "status": "A",
        "authorized_official_last_name": "WEED",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "405-951-2737"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INTEGRIS HEALTH MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ponca City, OK

Sources for this page

Verify at the official NPI Registry.