NPIMap

Organization Active NPI

Williams Medical Group Practice, LLC

  • Rural Health Clinic/Center
  • Jenks, OK
National Provider Identifier
1619740503
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WILLIAMS MEDICAL GROUP PRACTICE, LLC
Practice address
11462 S Union Ave Ste F
Jenks, OK 74037-6901
Phone
(918) 518-0220
Fax
(539) 664-9562
NPI assigned
Nov 1, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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

Authorized official

Name
Grant Asay
Title
Ceo
Phone
(405) 445-1210

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

11462 S Union Ave Ste F
Jenks, OK 74037-6901

Mailing address

701 Cedar Lake Blvd Ste 120
Oklahoma City, OK 73114-7815
Phone (405) 445-1210

Other names 1

  • Xpress Wellness Urgent Care Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231128000222 OK Part A Provider - Rural Health Clinic 3375832157 Practice locations: Jenks, OK

Rural health clinic certification: CCN 373905

Legal name
WILLIAMS MEDICAL GROUP PRACTICE, LLC
Doing business as
XPRESS WELLNESS URGENT CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 13, 2024
Last certification
Feb 13, 2024
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Dec 9, 2015 in KS
Enrollment address
11462 S Union Ave
Ste F
Jenks, OK 74037-6901

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
37D2292134Xpress Wellness Urgent Care11462 S Union Ave, Ste F, Jenks, OK 74037Certificate of waiverOct 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Williams Medical Group Practice LLC36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

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

View all 35

Locations

3800 10th St
Great Bend, KS 67530
Phone (620) 603-4216

2501 N 14th St
Ponca City, OK 74601
Phone (580) 749-5076

4296 N Harrison St
Shawnee, OK 74804
Phone (405) 788-4102

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Joseph M Moore Individual 5% Or Greater Direct Ownership InterestMD Aug 21, 2023 49%
Xpress Wellness LLC Organization, Oklahoma City, OK Management services company Operational/Managerial Control Jul 20, 2018
Tony Hill Individual 5% Or Greater Direct Ownership InterestD.O./Cmo Aug 21, 2023 51%
Corporate OfficerChief Medical Officer Nov 1, 2022
W-2 Managing Employee Nov 1, 2022

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Tony R Hill, DO
    • Emergency Medical Services (Emergency Medicine) Physician
    • Broken Arrow, OK
    • NPI 1295723245

    5% Or Greater Direct Ownership Interest, Corporate Officer, W-2 Managing Employee

    CMS ownership
  • Joseph Michael Moore, MD
    • Internal Medicine Physician
    • Tulsa, OK
    • NPI 1104853142

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 46

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

View all 46

Practitioners & affiliated clinicians

Practitioners 5

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": "1698796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698796800000",
    "number": "1619740503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 CEDAR LAKE BLVD STE 120",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731147815",
            "telephone_number": "405-445-1210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11462 S UNION AVE STE F",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740376901",
            "telephone_number": "918-518-0220",
            "fax_number": "539-664-9562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMS MEDICAL GROUP PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-01",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A",
        "authorized_official_last_name": "ASAY",
        "authorized_official_first_name": "GRANT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-445-1210"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Xpress Wellness Urgent Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jenks, OK

Sources for this page

Verify at the official NPI Registry.