NPIMap

Organization Active NPI

Grand Lake Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Barnsdall, OK
National Provider Identifier
1609249390
Registry record updated Jul 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
GRAND LAKE MENTAL HEALTH CENTER, INC.
Practice address
401 W Main St
Barnsdall, OK 74002
Phone
(918) 337-8080
Fax
(918) 337-8099
NPI assigned
Nov 4, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2020

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

Authorized official

Name
Larry Smith
Title
Ceo
Phone
(918) 273-1841

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

401 W Main St
Barnsdall, OK 74002

Mailing address

114 W Delaware Ave
Nowata, OK 74048-2601
Phone (918) 273-1841

Other names 1

  • Grand Lake Medical Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091026000174 OK Part B Supplier - Clinic/Group Practice 4688711534 Receives reassigned benefits from 341 practitioners
44 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pawhuska, OK; Perry, OK; Ponca City, OK; Pryor, OK; Skiatook, OK; Stillwater, OK; Claremore, OK; Tulsa, OK…

Other NPIs on the same Medicare enrollment 44

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

View all 44

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1446595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596153600000",
    "number": "1609249390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 W DELAWARE AVE",
            "city": "NOWATA",
            "state": "OK",
            "postal_code": "740482601",
            "telephone_number": "918-273-1841",
            "fax_number": "918-273-1843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W MAIN ST",
            "city": "BARNSDALL",
            "state": "OK",
            "postal_code": "74002",
            "telephone_number": "918-337-8080",
            "fax_number": "918-337-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LAKE MENTAL HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-04",
        "last_updated": "2020-07-31",
        "certification_date": "2020-07-31",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-273-1841"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Lake Medical Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Barnsdall, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.