NPIMap

Organization Active NPI

Jackson County Memorial Hospital Authority

Doing business as Jackson County Memorial Hospital Home Care

  • Home Health Agency
  • Altus, OK
National Provider Identifier
1699724757
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
7150 Issued in OK
Legal business name
JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY
Doing business as
Jackson County Memorial Hospital Home Care
Practice address
1204 E Tamarack Rd
Altus, OK 73521-1234
Phone
(580) 379-6900
Fax
(580) 379-6909
NPI assigned
May 8, 2006
Last updated
Oct 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Authorized official

Name
Mr. Steve Hartgraves
Title
President/Ceo
Phone
(580) 379-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 7150 OK Primary

Addresses

Primary practice location

1204 E Tamarack Rd
Altus, OK 73521-1234

Mailing address

1204 E Tamarack Rd
Altus, OK 73521-1234
Phone (580) 379-6900

Other identifiers 1

IdentifierTypeStateIssuer
100699350AMedicaidOK

Other names 1

  • Jackson County Memorial Hospital Home Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080117000154 OK Part A Provider - Home Health Agency 1759293178 Practice locations: Altus, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699724757. Details of each certification follow.

Home health agency certification: CCN 377137

Legal name
JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY
Doing business as
JACKSON COUNTY MEMORIAL HOSPITAL HOSPICE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 21, 1985
Last certification
Apr 13, 2021
Ownership / control type
Non-Profit
Organization structure
OtherNon-profit
Enrollment address
1204 E Tamarack Rd
Altus, OK 73521-1234

Other NPIs with the same Medicare PAC ID 8

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Jackson County Memorial Hospital AuthorityCCN 377137 · All quality measures
Overall star rating
3.5 of 5
Ownership
Non-Profit
Certified
Nov 21, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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
37D0472216Jackson County Memorial Hosp Home Care1204 E Tamarack, Altus, OK 73521Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Jackson County Memorial Hospital Skilled Nursing Facility11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Jackson County Memorial Hospital Authority Organization, Altus, OK Operational/Managerial Control Feb 1, 2012 100%
Elizabeth Renee Whiting Individual W-2 Managing Employee Nov 16, 2011
Steven L Hartgraves Individual Corporate DirectorPresident/Ceo Mar 15, 2014 100%

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Jackson County Memorial HospitalAltus, OK, CCN 370022 Hospital 5% Or Greater Direct Ownership Interest Jul 1, 2010
Jackson County Memorial HospitalAltus, OK, CCN 37U022 Hospital 5% Or Greater Direct Ownership Interest Jul 1, 2010
Harmon Memorial HospitalHollis, OK, CCN 371338 Hospital 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2019
Harmon Memorial HospitalHollis, OK, CCN 37Z338 Hospital 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2019
Jackson County Memorial Hospital HospiceAltus, OK, CCN 371540 Hospice Operational/Managerial Control Jan 1, 2008

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1699724757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 E TAMARACK RD",
            "city": "ALTUS",
            "state": "OK",
            "postal_code": "735211234",
            "telephone_number": "580-379-6900",
            "fax_number": "580-379-6909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 E TAMARACK RD",
            "city": "ALTUS",
            "state": "OK",
            "postal_code": "735211234",
            "telephone_number": "580-379-6900",
            "fax_number": "580-379-6909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "HARTGRAVES",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "580-379-5000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OK",
            "license": "7150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100699350A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson County Memorial Hospital Home Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jackson County Memorial Hospital Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Altus, OK

Sources for this page

Verify at the official NPI Registry.