NPIMap

Organization Active NPI

Community Health Center of Northeast Oklahoma, Inc.

Doing business as Commerce Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Commerce, OK
National Provider Identifier
1699318550
Registry record updated Jan 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTER OF NORTHEAST OKLAHOMA, INC.
Doing business as
Commerce Community Health Center
Practice address
220 S Mickey Mantle Blvd
Commerce, OK 74339-2924
Phone
(918) 257-8029
Fax
(918) 257-8042
NPI assigned
Oct 23, 2019
Last updated
Jan 15, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY HEALTH CENTER OF NE OKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 15, 2020

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

Authorized official

Name
Janet Mendez
Title
Ceo
Phone
(918) 257-8029

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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 1

  • Commerce Community Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699318550. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Sep 16, 2010 in OK
Enrollment address
220 S Mickey Mantle Blvd
Commerce, OK 74339-2924

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Part of
Community Health Center of

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Carol Mosier Individual W-2 Managing EmployeeFront Office Supervisor/Billing Sup Mar 19, 2026
Janet Mendez Individual Corporate OfficerCeo Oct 1, 2019 100%
W-2 Managing EmployeeCeo Oct 1, 2019 100%

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Route 66 Health ClinicAfton, OK, CCN 371892 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 16, 2010
Route 66 Health ClinicWelch, OK, CCN 371930 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2019
Allensworth Community Health CenterVinita, OK, CCN 371940 Federally qualified health center Operational/Managerial Control (100%) Feb 11, 2019
Chcneo Jay Family Medicine ClinicJay, OK, CCN 371963 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2021

Owned or controlled facilities with NPI records 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1571788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579046400000",
    "number": "1699318550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 705",
            "city": "AFTON",
            "state": "OK",
            "postal_code": "743310705",
            "telephone_number": "918-257-8029",
            "fax_number": "918-257-8042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 S MICKEY MANTLE BLVD",
            "city": "COMMERCE",
            "state": "OK",
            "postal_code": "743392924",
            "telephone_number": "918-257-8029",
            "fax_number": "918-257-8042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF NORTHEAST OKLAHOMA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY HEALTH CENTER OF NE OK",
        "enumeration_date": "2019-10-23",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A",
        "authorized_official_last_name": "MENDEZ",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-257-8029"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Commerce Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Commerce Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Commerce, OK

Sources for this page

Verify at the official NPI Registry.