Active NPI
St John Sapulpa, Inc
- Critical Access Hospital
- Sapulpa, OK
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Access Hospital
- License
- 2310
- Legal business name
- ST JOHN SAPULPA, INC
- Practice address
- 1004 E Bryan Ave
Sapulpa, OK 74066-4513 - Phone
- (918) 224-4280
- Fax
- (918) 224-6290
- NPI assigned
- Jun 4, 2008
- Last updated
- Jan 23, 2014
- Organization subpart
- Yes
- Parent organization
- ST JOHN SAPULPA, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. David L. Phillips
- Title
- Coo
- Phone
- (918) 227-8601
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | 2310 | OK | Primary |
Addresses
Primary practice location
1004 E Bryan Ave
Sapulpa, OK 74066-4513
Mailing address
PO Box 1368
Sapulpa, OK 74067-1368
Phone (918) 224-4280
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000370033001 | Other | OK | BLUE CROSS BLUE SHIELD |
| 100699550 | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081014000321 | OK | Part A Provider - Critical Access Hospital | 6507850211 | Practice locations: Sapulpa, OK |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1669631792. Details of each certification follow.
Hospital certification: CCN 37Z312
- Legal name
- ST JOHN SAPULPA INC
- Organization structure
- Corporation
- Enrollment address
- 1004 E Bryan Ave
Sapulpa, OK 74066-4513
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Tax ID family
- Sands Springs Medical
- Part of
- Sands Springs Medical
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Critical Access Hospital
- Sapulpa, OK
- NPI 1861794448
Ownership & related parties
All disclosed owners & managing parties 9
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Sheila Vancuren | Operational/Managerial Control | Aug 1, 2025 | 10% |
| Catherine Gebetsberger | Corporate Director | Nov 2, 2022 | 10% |
| Brian Mithcell | Operational/Managerial Control | Aug 1, 2025 | 10% |
| Joshua Zachariah Vicena | Corporate Director | Jan 1, 2024 | 10% |
| Mark Lawson | Operational/Managerial Control | Aug 1, 2025 | 10% |
| Mark Clay | Corporate Officer | Aug 1, 2025 | 10% |
| Lisa Ford | Operational/Managerial Control | Aug 1, 2025 | 10% |
| Thomas Kimball | Operational/Managerial Control | Aug 1, 2025 | 10% |
| Heather Turner | Operational/Managerial Control | Aug 1, 2025 | 10% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
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.
-
- Family Medicine Physician
- Sapulpa, OK
- NPI 1154390672
Affiliated clinicians 3
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212537600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1390435200000",
"number": "1669631792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1368",
"city": "SAPULPA",
"state": "OK",
"postal_code": "740671368",
"telephone_number": "918-224-4280",
"fax_number": "918-224-6290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1004 E BRYAN AVE",
"city": "SAPULPA",
"state": "OK",
"postal_code": "740664513",
"telephone_number": "918-224-4280",
"fax_number": "918-224-6290"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST JOHN SAPULPA, INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ST JOHN SAPULPA, INC.",
"enumeration_date": "2008-06-04",
"last_updated": "2014-01-23",
"status": "A",
"authorized_official_last_name": "PHILLIPS",
"authorized_official_first_name": "DAVID",
"authorized_official_middle_name": "L.",
"authorized_official_title_or_position": "COO",
"authorized_official_telephone_number": "918-227-8601",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "282NC0060X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital, Critical Access",
"state": "OK",
"license": "2310",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "000370033001",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100699550",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sapulpa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.