NPIMap

Organization Active NPI

Great Salt Plains Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Medford, OK
National Provider Identifier
1699025973
Registry record updated Sep 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREAT SALT PLAINS HEALTH CENTER, INC.
Practice address
619 Front Street
Medford, OK 73759-1209
Phone
(580) 395-3200
Fax
(580) 596-2805
NPI assigned
Sep 14, 2012
Organization subpart
Yes
Parent organization
GREAT SALT PLAINS HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 22, 2020

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

Authorized official

Name
Tim Starkey
Title
Ceo
Phone
(580) 596-2800

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X
Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VG0400X
Pediatric Adolescent Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080A0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

619 Front Street
Medford, OK 73759-1209

Mailing address

405 S Oklahoma Ave
Cherokee, OK 73728-2545
Phone (580) 596-2800

Other names 1

  • GSP Health Medford Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130402000223 OK Part A Provider - Federally Qualified Health Center (FQHC) 9133201171 Practice locations: Medford, OK

Federally qualified health center certification: CCN 371880

Legal name
GREAT SALT PLAINS HEALTH CENTER INC
Doing business as
GSP MEDFORD
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 11, 2012
Last certification
Oct 11, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 6, 2007 in OK
Enrollment address
619 N Front St
Medford, OK 73759-2704

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Great Salt Plains Health Center Inc9 organizations share this tax ID, including this one
Part of
Great Salt Plains Health Center Inc

Other organizations with this tax ID 8

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

Locations

619 N Front St
Medford, OK 73759
Phone (580) 395-3200

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Leslie Collins Individual Corporate OfficerPresident of Board Nov 25, 2014
Robert Brown Individual Corporate DirectorBoard Member Mar 15, 2011
Donnis F Kent Individual Corporate DirectorBoard Member Jul 21, 2015
Susie Koontz Individual Corporate OfficerSecretary of Board Sep 1, 2007
Barbara Hudgens Individual Corporate DirectorBoard Member Sep 1, 2007
Timothy Starkey Individual Corporate Director Apr 1, 2008
W-2 Managing Employee Apr 1, 2008
Operational/Managerial Control Apr 1, 2008
Martha Royster Individual Corporate DirectorBoard Member Oct 18, 2016
Aaron Hughes Individual Corporate DirectorBoard Member Aug 8, 2022
Gail Ridgeway Individual Corporate DirectorBoard Member Aug 8, 2022
Terry . Mote Individual Corporate DirectorBoard Member Aug 8, 2022
James Edmison Individual Corporate DirectorBoard Member Apr 17, 2018
Jorge Guerrero Individual Corporate DirectorBoard Member Aug 8, 2022
Brandi Schieber Individual Corporate DirectorBoard Member Aug 8, 2022
Karen Hawkins Individual Corporate OfficerVice President of Board Sep 1, 2007

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600732800000",
    "number": "1699025973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 S OKLAHOMA AVE",
            "city": "CHEROKEE",
            "state": "OK",
            "postal_code": "737282545",
            "telephone_number": "580-596-2800",
            "fax_number": "580-596-2805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 FRONT STREET",
            "city": "MEDFORD",
            "state": "OK",
            "postal_code": "737591209",
            "telephone_number": "580-395-3200",
            "fax_number": "580-596-2805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT SALT PLAINS HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREAT SALT PLAINS HEALTH CENTER",
        "enumeration_date": "2012-09-14",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A",
        "authorized_official_last_name": "STARKEY",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-596-2800"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GSP Health Medford",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GSP Health Medford",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medford, OK

Sources for this page

Verify at the official NPI Registry.