Active NPI
Grand Lake Health Care, LLC
- Nurse Practitioner
- Grove, OK
National Provider Identifier
1619459708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 80573
- Legal business name
- GRAND LAKE HEALTH CARE, LLC
- Practice address
- 601 S Broadway St
Grove, OK 74344-3429 - Phone
- (918) 801-6085
- NPI assigned
- Sep 5, 2018
- Last updated
- Feb 25, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Joseph James Gelinas, NP
- Title
- Owner/Provider
- Phone
- (918) 787-3491
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 80573 | OK | Primary |
Addresses
Primary practice location
601 S Broadway St
Grove, OK 74344-3429
Mailing address
62500 E 247 Loop
Grove, OK 74344-7435
Phone (918) 787-5240
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20313460A | Medicaid | OK |
National Provider Directory
National Provider DirectoryInteroperability endpoints
- https://api.platform.athenahealth.com/18190/brand/1/csg/1/fhir/r4
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.
-
- Nurse Practitioner
- Grove, OK
- NPI 1396045753
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536105600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1551052800000",
"number": "1619459708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "62500 E 247 LOOP",
"city": "GROVE",
"state": "OK",
"postal_code": "743447435",
"telephone_number": "918-787-5240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 S BROADWAY ST",
"city": "GROVE",
"state": "OK",
"postal_code": "743443429",
"telephone_number": "918-801-6085"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GRAND LAKE HEALTH CARE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-09-05",
"last_updated": "2019-02-25",
"status": "A",
"authorized_official_last_name": "GELINAS",
"authorized_official_first_name": "JOSEPH",
"authorized_official_middle_name": "JAMES",
"authorized_official_title_or_position": "OWNER/PROVIDER",
"authorized_official_telephone_number": "918-787-3491",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "NP"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": "OK",
"license": "80573",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "20313460A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grove, OK
- Marvin L Goodman, CRNA
- Jeremy Elijah Gordon
- Tiffany Dawn Gorman
- Grand Lake Chiropractic PLLC
- Grand Lake Eye Care, PC
- Grand Lake Imaging PC
- Grand Lake Mental Health Center Inc (Grand Lake Medical Health Center)
- Grand Lake Mental Health Center, Inc. (GRAND Mental Health)
- Grand Lake Mental Health Center, Inc. (GRAND Mental Health)
- Grand Lake Mental Health Center, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.