NPIMap

Organization Active NPI

Mercy Hospital Logan County, Inc

Doing business as Mercy Hospital Logan County Crescent Primary Care

  • Rural Health Clinic/Center
  • Crescent, OK
National Provider Identifier
1659652071
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY HOSPITAL LOGAN COUNTY, INC
Doing business as
Mercy Hospital Logan County Crescent Primary Care
Practice address
400 S Grand
Crescent, OK 73028-9118
Phone
(405) 969-2818
NPI assigned
Aug 30, 2011
Last updated
Sep 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

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

Authorized official

Name
Sherry Clouse Day
Title
Vice President Finance
Phone
(417) 820-8439

Specialties & licenses 1

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

Addresses

Primary practice location

400 S Grand
Crescent, OK 73028-9118

Mailing address

400 S Grand
Crescent, OK 73028-9118
Phone (405) 969-2818

Other identifiers 1

IdentifierTypeStateIssuer
37-3990OtherOKMEDICARE PROVIDER #

Other names 1

  • Mercy Hospital Logan County Crescent Primary Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110930000610 OK Part A Provider - Rural Health Clinic 4587836200 Practice locations: Crescent, OK
O20121004000289 OK Part B Supplier - Clinic/Group Practice 4587836200 Receives reassigned benefits from 205 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Guthrie, OK; Crescent, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659652071. Details of each certification follow.

Rural health clinic certification: CCN 373990

Legal name
MERCY HOSPITAL LOGAN COUNTY, INC
Doing business as
MERCY HOSPITAL LOGAN COUNTY-CRESCENT PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 9, 1993
Last certification
Apr 29, 2014
Ownership / control type
2B
Most recent change of ownership
Oct 1, 2011 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Aug 15, 2011 in OK
Enrollment address
400 S Grand
Crescent, OK 73028-9118
Related CCNs
371317

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

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Mercy Hospital Logan County2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

400 S Grand St
Crescent, OK 73028
Phone (405) 282-6700

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Jamie Wilke Individual Corporate OfficerSecretary Jul 1, 2024
John M Mohart Individual Corporate Director Jul 1, 2021
Yogya Regmi Individual W-2 Managing EmployeeDirector Aug 29, 2022
Daniel W Calvert Individual Corporate DirectorBoard Member Jul 1, 2021
Robin G Channel Individual Corporate DirectorBoard Member Jul 1, 2021
Jeffrey Peter Ciaramita Individual Corporate DirectorBoard Member Jul 1, 2021
Dustin Yowell Individual Corporate DirectorBoard Member Jul 1, 2022
Mercy Health Organization, Chesterfield, MO Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Oct 2, 2011 100%
Mercy Health Oklahoma Communities Organization, Oklahoma City, OK Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 11, 2012 100%
Mercy Hospital Oklahoma City, Inc Organization, Oklahoma City, OK Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jul 1, 2014 100%
Sherry Clouse Day Individual Corporate OfficerTreasurer Jan 1, 2021
W-2 Managing EmployeeVP of Finance-Cah Jan 1, 2021
Bobby J Stitt Individual Corporate OfficerPresident Jul 1, 2021
Brian Bennett Geister Individual Corporate OfficerCommunity President May 28, 2024

Owners & managing parties with NPI records 8

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

Facilities with the same owner 120

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

View all 120

Practitioners & affiliated clinicians

Practitioners 206

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.

View all 206

NPI Registry JSON

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

{
    "created_epoch": "1314662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1659652071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S GRAND",
            "city": "CRESCENT",
            "state": "OK",
            "postal_code": "730289118",
            "telephone_number": "405-969-2818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S GRAND",
            "city": "CRESCENT",
            "state": "OK",
            "postal_code": "730289118",
            "telephone_number": "405-969-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL LOGAN COUNTY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-30",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "CLOUSE DAY",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_title_or_position": "VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "417-820-8439"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER #",
            "identifier": "37-3990",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Hospital Logan County Crescent Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Hospital Logan County Crescent Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crescent, OK

Sources for this page

Verify at the official NPI Registry.