Community Health Center of Northeast Oklahoma, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Commerce, OK
NPI 1699318550 · NPPES record last updated Jan 15, 2020
Key facts
- NPI
- 1699318550
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY HEALTH CENTER OF NORTHEAST OKLAHOMA, INC.
- Practice address
- 220 S Mickey Mantle Blvd
Commerce, OK 74339-2924 - Phone
- (918) 257-8029
- Fax
- (918) 257-8042
- NPI assigned
- Oct 23, 2019
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMUNITY HEALTH CENTER OF NE OK
Authorized official
- Name
- Janet Mendez
- Title
- Ceo
- Phone
- (918) 257-8029
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 4
Practitioners 5
-
Russell Allen Peters, APRN
-
Laura Broussard, APRN
-
Peggy Stanley, NP-C
-
Shounda Turley, APRN-NPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OK
Federally qualified health center certification: CCN 371952
- Legal name
- COMMUNITY HEALTH CENTER OF NORTHEAST OKLAHOMA, INC
- Doing business as
- COMMERCE COMMUNITY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 13, 2019
- Last certification
- Dec 13, 2019
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 16, 2010 in OK
- Enrollment address
- 220 S Mickey Mantle Blvd
Commerce, OK 74339-2924
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Carol Mosier |
W-2 Managing Employee |
Mar 19, 2026 | |
| Janet Mendez |
Corporate Officer |
Oct 1, 2019 | 100% |
| W-2 Managing Employee |
Oct 1, 2019 | 100% |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Route 66 Health Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 16, 2010 |
| Route 66 Health Clinic |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 1, 2019 |
| Allensworth Community Health Center |
Federally qualified health center | Operational/Managerial Control (100%) | Feb 11, 2019 |
| Chcneo Jay Family Medicine Clinic |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140610000303 | OK | Part B Supplier - Clinic/Group Practice | 9133352081 |
Receives reassigned benefits from 12 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Afton, OK; Commerce, OK; Jay, OK; Vinita, OK; Welch, OK |
| O20191216000685 | OK | Part a Provider - Federally Qualified Health Center (FQHC) | 9133352081 | Practice locations: Commerce, OK |
National Provider Directory
- Part of
- Community Health Center of Northeast Oklahoma
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
220 S Mickey Mantle Blvd
Commerce, OK 74339-2924
Mailing address
PO Box 705
Afton, OK 74331-0705
Phone (918) 257-8029
Other names
- Commerce Community Health Center
Other providers in Commerce, OK
- Jennifer Jean Callahan
- Commerce Public Schools
- Michelle Deshazer
- Eastwood Manor, LLC
- Greg Fent
- Johnny Frost
- Joseph Goldman
All providers in Commerce, OK · Federally Qualified Health Center (FQHC) in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.