NPIMap

Organization Active NPI

Northeastern Health System

  • Addiction (Substance Use Disorder) Counselor
  • Tahlequah, OK
National Provider Identifier
1689338519
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
NORTHEASTERN HEALTH SYSTEM
Practice address
1323 W Keetoowah St
Tahlequah, OK 74464-3462
Phone
(918) 506-6901
NPI assigned
Oct 27, 2021
Last updated
Nov 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Authorized official

Name
Jackie Hullinger
Title
VP of Revenue Cycle
Phone
(918) 458-2417

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU Primary

Addresses

Primary practice location

1323 W Keetoowah St
Tahlequah, OK 74464-3462

Mailing address

PO Box 1008
Tahlequah, OK 74465-1008
Phone (918) 458-2111

Other practice location 1

215 NE 1st St Ste B
Wagoner, OK 74467-4439
Phone (918) 931-3890

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments
Opioid treatment program
Medicare-enrolled since Aug 14, 2023

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050519001008 OK Part A Provider - Hospital 1456255025 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tahlequah, OK
O20231016000910 OK Part B Supplier - Opioid Treatment Program (Otp) 1456255025 Practice locations: Tahlequah, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689338519. Details of each certification follow.

Hospital certification: CCN 370089

Legal name
NORTHEASTERN HEALTH SYSTEM
Doing business as
TAHLEQUAH CITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jun 4, 2025
Beds
98
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Enrollment address
1400 E Downing St
Tahlequah, OK 74464-3324
Other Hospital Practice Location
Hospital subgroups
General

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

Other NPIs with the same Medicare PAC ID 7

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.

Care Compare: Hospital

Medicare Care Compare
Listed as
Northeastern Health SystemCCN 370089 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
37D2260969Northeastern Health System Addiction Resource Ctr1323 W Keetoowah St, Tahlequah, OK 74464Certificate of waiverMay 24, 2028

National Provider Directory

National Provider Directory

Locations

215 NE 1st St
Ste B
Wagoner, OK 74467
Phone (918) 931-3890

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
James Berry Individual Corporate OfficerVP Sep 1, 2016
Northeastern Health System Organization, Tahlequah, OK Operational/Managerial Control May 1, 2008
Brian Woodliff Individual Corporate Director May 19, 2005
W-2 Managing Employee May 19, 2005
Christine Jankas Individual Corporate OfficerVP Physician Services May 14, 2019

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tahlequah City HospitalTahlequah, OK, CCN 370089 Hospital Operational/Managerial Control May 1, 2008
Tahlequah City HospitalTahlequah, OK, CCN 37S089 Hospital Operational/Managerial Control Oct 1, 2002
Tahlequah City HospitalTahlequah, OK, CCN 37T089 Hospital Operational/Managerial Control Jan 1, 1974

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 335

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 335

NPI Registry JSON

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

{
    "created_epoch": "1635292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1689338519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1008",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744651008",
            "telephone_number": "918-458-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1323 W KEETOOWAH ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643462",
            "telephone_number": "918-506-6901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 NE 1st St Ste B",
            "address_purpose": "LOCATION",
            "city": "Wagoner",
            "state": "OK",
            "postal_code": "744674439",
            "country_code": "US",
            "telephone_number": "918-931-3890",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHEASTERN HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-27",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "HULLINGER",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "VP OF REVENUE CYCLE",
        "authorized_official_telephone_number": "918-458-2417"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tahlequah, OK

Sources for this page

Verify at the official NPI Registry.