Organization Active NPI

Home Run Healthcare

  • Geriatric Medicine (Family Medicine) Physician
  • Idabel, OK
National Provider Identifier
1568957348
Registry record updated Jun 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
HOME RUN HEALTHCARE
Practice address
1425 East Lincoln Road
Suite a-3
Idabel, OK 74745
Phone
(580) 212-7237
NPI assigned
Jun 25, 2018
Last updated
Jun 25, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2018

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

Authorized official

Name
Ashlei Jobe, NURSE PRACTIONERNPI 1679013676
Title
President
Phone
(580) 212-7237

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X Primary

Addresses

Primary practice location

1425 East Lincoln Road
Suite a-3
Idabel, OK 74745

Mailing address

PO Box 51
Garvin, OK 74736-0051
Phone (580) 212-7237

Other identifiers 1

IdentifierTypeStateIssuer
1679013676MedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180918002495 OK Part B Supplier - Clinic/Group Practice 3173874997 Receives reassigned benefits from 1 practitioner
Practice locations: Idabel, OK

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
37D2151070Home Run Healthcare1425 E Lincoln Rd, Suite a-3, Idabel, OK 74745Certificate of waiverJul 10, 2028

National Provider Directory

National Provider Directory

Locations

1425 E Lincoln Rd
Ste A3
Idabel, OK 74745
Phone (580) 208-2970

Practitioners & affiliated clinicians

Practitioners 1

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": "1529884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529884800000",
    "number": "1568957348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51",
            "city": "GARVIN",
            "state": "OK",
            "postal_code": "747360051",
            "telephone_number": "580-212-7237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 EAST LINCOLN ROAD",
            "address_2": "SUITE A-3",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "74745",
            "telephone_number": "580-212-7237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOME RUN HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-25",
        "last_updated": "2018-06-25",
        "status": "A",
        "authorized_official_last_name": "JOBE",
        "authorized_official_first_name": "ASHLEI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "580-212-7237",
        "authorized_official_credential": "NURSE PRACTIONER"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679013676",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Idabel, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.