NPIMap

Organization Active NPI

Integris Bass Baptist Health Center

Doing business as Integris Home Care Enid

  • Home Health Agency
  • Enid, OK
National Provider Identifier
1700807997
Registry record updated Aug 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
2244 Issued in OK
Legal business name
INTEGRIS BASS BAPTIST HEALTH CENTER
Doing business as
Integris Home Care Enid
Practice address
401 S 3Rd St
Enid, OK 73701-5737
Phone
(580) 548-1116
NPI assigned
Jul 22, 2006
Last updated
Aug 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2024

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

Authorized official

Name
Donna Wallace
Title
Assistant Treasurer
Phone
(636) 359-4890

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 2244 OK Primary

Addresses

Primary practice location

401 S 3Rd St
Enid, OK 73701-5737

Mailing address

PO Box 200731
Dallas, TX 75320-0731
Phone (405) 252-8319

Other identifiers 1

IdentifierTypeStateIssuer
100699500HMedicaidOK

Other names 1

  • Integris Home Care Enid Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031103000717 OK Part B Supplier - Clinic/Group Practice 0345151981 Receives reassigned benefits from 28 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Medford, OK; Hennessey, OK; Enid, OK
O20080908000316 OK Part A Provider - Home Health Agency 0345151981 Practice locations: Enid, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700807997. Details of each certification follow.

Home health agency certification: CCN 377208

Legal name
INTEGRIS BASS BAPTIST HEALTH CENTER
Doing business as
INTEGRIS HOME CARE ENID
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 23, 1992
Last certification
Jun 13, 2019
Ownership / control type
Non-Profit
Organization structure
LLCNon-profit
Enrollment address
401 S 3Rd St
Enid, OK 73701-5737

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 17

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

View all 17

Care Compare: Home health agency

Medicare Care Compare
Listed as
Integris Home Care EnidCCN 377208 · All quality measures
Overall star rating
3 of 5
Ownership
Non-Profit
Certified
Dec 23, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Physical therapy, 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
37D0895624Integris Home Care Enid401 S 3Rd, Enid, OK 73701Certificate of waiverJul 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
Bass Memorial Baptist Hospital Dba Integris Bass Baptist Health Center9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Christina Hopper Individual Corporate Officer Jul 1, 2024
Corporate Director Jul 1, 2024
Donna M Wallace Individual Corporate Officer Oct 27, 2023
Mark a McCulley Individual Corporate Director Jul 1, 2020
Christopher a Shearer Individual Corporate Director Apr 20, 2005
Brian D Atwood Individual Corporate Director Jan 1, 2002
Michael S Jackson Individual Corporate Officer May 1, 2019
Jason Turnbow Individual Corporate Director Jul 1, 2024
Michael L Weed Individual Corporate Officer Jan 1, 2023
Justin L Funk Individual Corporate Director Jul 1, 2024
Gretchen a Cinnamon Grauberger Individual Contracted Managing EmployeeAd; Jul 10, 2020
Operational/Managerial ControlAdministrator Jul 10, 2020
Megan J Darrow Individual Corporate Director Jul 1, 2021
Casey Ahlden Individual Corporate Officer Jan 1, 2023
Integris Health Inc Organization, Oklahoma City, OK Corporation, Non-profit, Chain home office Operational/Managerial Control Jul 1, 1994
Brent Hubbard Individual Corporate Officer Jul 1, 2022
Corporate Director Jul 1, 2022
John R Bullis Individual Corporate Officer Jul 1, 2024
Corporate Director Jul 1, 2021
Baptist Healthcare of Oklahoma LLC Organization, Oklahoma City, OK LLC, Non-profit Operational/Managerial Control Jun 7, 1978
Brian Winter Individual Corporate Director Jul 1, 2024
Keaton Francis Individual Corporate Officer Jan 9, 2023
Integris Rural Health Inc Organization, Oklahoma City, OK Corporation, Non-profit Operational/Managerial Control Jul 1, 1994
Jonathan C Bartley Individual Corporate Officer Jul 1, 2024
Corporate Director Jul 1, 2020
Aaron Harmon Individual Corporate Director Jul 1, 2024
Casey Felix Individual Corporate Director Jul 1, 2018
Best Chen Individual Corporate Officer Jul 1, 2024
Corporate Director Jul 1, 2024

Owners & managing parties with NPI records 4

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

Facilities with the same owner 31

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

View all 31

Practitioners & affiliated clinicians

Affiliated clinicians 7

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

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723420800000",
    "number": "1700807997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 200731",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753200731",
            "telephone_number": "405-252-8319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 S 3RD ST",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737015737",
            "telephone_number": "580-548-1116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRIS BASS BAPTIST HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "ASSISTANT TREASURER",
        "authorized_official_telephone_number": "636-359-4890"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OK",
            "license": "2244",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100699500H",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integris Home Care Enid",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Enid, OK

Sources for this page

Verify at the official NPI Registry.