NPIMap

Organization Active NPI

Integris Health Woodward Hospital Inc

Doing business as Integris Health Medical Group

  • Rural Health Clinic/Center
  • Woodward, OK
National Provider Identifier
1649042284
Registry record updated Dec 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
INTEGRIS HEALTH WOODWARD HOSPITAL INC
Doing business as
Integris Health Medical Group
Practice address
1818 Kansas Ave
Woodward, OK 73801-2912
Phone
(580) 256-2188
NPI assigned
Oct 26, 2023
Last updated
Dec 21, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
INTEGRIS HEALTH WOODWARD HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 21, 2023

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

Authorized official

Name
Donna Wallace
Title
Assistant Treasurer
Phone
(636) 359-4890

Specialties & licenses 1

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

Addresses

Primary practice location

1818 Kansas Ave
Woodward, OK 73801-2912

Mailing address

3001 Quail Springs Pkwy FL 3
Oklahoma City, OK 73134-2640
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
O20240112001071 OK Part A Provider - Rural Health Clinic 0840641825 Practice locations: Woodward, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649042284. Details of each certification follow.

Rural health clinic certification: CCN 373476

Legal name
INTEGRIS HEALTH WOODWARD HOSPITAL INC
Doing business as
INTEGRIS HEALTH MEDICAL GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 14, 2013
Last certification
Jun 13, 2019
Ownership / control type
1B
Most recent change of ownership
Nov 1, 2023 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Jul 31, 2023 in OK
Enrollment address
1818 Kansas Ave
Woodward, OK 73801-2912
Related CCNs
370002

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

Other NPIs with the same Medicare PAC ID 6

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
37D1104078Integris Health Woodward Hospital1818 Kansas Ave, Woodward, OK 73801Certificate of waiverAug 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Integris Health Woodward Hospital Inc7 organizations share this tax ID, including this one
Part of
Integris Health Woodward Hospital Inc

Other organizations with this tax ID 6

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

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
John Brown Individual Contracted Managing EmployeeChief Hospital Executive Nov 1, 2023
Corporate OfficerChief Hospital Executive Nov 1, 2023
Operational/Managerial ControlChief Hospital Executive Nov 1, 2023
Donna M Wallace Individual Corporate OfficerAssistant Treasurer Oct 31, 2023
Michael L Weed Individual Contracted Managing EmployeeTreasurer Jul 31, 2023
Corporate OfficerTreasurer Oct 31, 2023
Operational/Managerial ControlTreasurer Jul 31, 2023
Integris Health Inc Organization, Oklahoma City, OK Corporation, Non-profit Operational/Managerial Control Jul 31, 2023
Brent Hubbard Individual Contracted Managing EmployeeSenior Vice President & Coo Jul 31, 2023
Corporate OfficerSenior Vice President & Coo Oct 31, 2023
Operational/Managerial ControlSenior Vice President & Coo Jul 31, 2023
Debbie Collier Individual Contracted Managing EmployeeDirector Physician Operations Nov 1, 2023
Operational/Managerial ControlDirector Physician Operations Nov 1, 2023
Kathryn a Ray Individual Contracted Managing EmployeeMedical Director Nov 1, 2023
Operational/Managerial ControlMedical Director Nov 1, 2023
Timothy Pehrson Individual Contracted Managing EmployeePresident & Ceo Jul 31, 2023
Corporate OfficerPresident & Ceo Oct 31, 2023
Corporate DirectorPresident & Ceo Jul 31, 2023
Operational/Managerial ControlPresident & Ceo Jul 31, 2023
OtherChain Home Office Administrator 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 Woodward ClinicsCCN 373476, OK, NPI 1730434424

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 6

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": "1703116800000",
    "number": "1649042284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 QUAIL SPRINGS PKWY FL 3",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731342640",
            "telephone_number": "405-252-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 KANSAS AVE",
            "city": "WOODWARD",
            "state": "OK",
            "postal_code": "738012912",
            "telephone_number": "580-256-2188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRIS HEALTH WOODWARD HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTEGRIS HEALTH WOODWARD HOSPITAL INC",
        "enumeration_date": "2023-10-26",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "ASSISTANT TREASURER",
        "authorized_official_telephone_number": "636-359-4890"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INTEGRIS HEALTH MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodward, OK

Sources for this page

Verify at the official NPI Registry.