NPIMap

Organization Active NPI

Oklahoma City Rehabilitation Hospital, LLC

  • Rehabilitation Hospital
  • Oklahoma City, OK
National Provider Identifier
1740813740
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation HospitalTaxonomy code 283X00000X
Legal business name
OKLAHOMA CITY REHABILITATION HOSPITAL, LLC
Practice address
10240 Broadway Extension
Ste. 320
Oklahoma City, OK 73114-7311
Phone
(469) 640-6503
NPI assigned
Feb 18, 2020
Last updated
Oct 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Authorized official

Name
Tracey Nixon
Title
Chief Compliance Officer
Phone
(469) 640-6503

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital 283X00000X Primary

Addresses

Primary practice location

10240 Broadway Extension
Ste. 320
Oklahoma City, OK 73114-7311

Mailing address

450 Century Pkwy Ste 220
Allen, TX 75013-8135
Phone (469) 640-6503

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler Other CMS HIH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220621001192 OK Part A Provider - Hospital 7315326410 Practice locations: Oklahoma City, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740813740. Details of each certification follow.

Hospital certification: CCN 373038

Legal name
OKLAHOMA CITY REHABILITATION HOSPITAL LLC
Certification status
Active
Provider type (POS)
Hospital – Rehabilitation
Participating since
Nov 29, 2022
Last certification
Nov 29, 2022
Beds
40
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Jan 15, 2020 in TX
Enrollment address
10240 Broadway Ext
Oklahoma City, OK 73114-6309
Main/Primary Hospital Location
Hospital subgroups
Rehabilitation

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Oklahoma City Rehabilitation Hospital, LLCCCN 373038 · All quality measures
Ownership
For profit
Certified
Nov 29, 2022
Medicare certification status
ActiveFrom the Provider of Services file

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
37D2264202Oklahoma City Rehabilitation Hospital, LLC10240 Broadway Ext, Oklahoma City, OK 73114Certificate of waiverJul 11, 2028

National Provider Directory

National Provider Directory

Locations

10240 Broadway Ext
Ste 320
Oklahoma City, OK 73114

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
Kennor Cross Opco Organization, Carrollton, TX LLC 5% Or Greater Indirect Ownership Interest Jul 28, 2025 25.29%
Tracey Nixon Individual 5% Or Greater Indirect Ownership Interest Jul 28, 2025 6.47%
Corporate OfficerChief Compliance Officer Jun 3, 2022
Shane Shoulders Individual 5% Or Greater Indirect Ownership Interest Jul 28, 2025 15.49%
Corporate Director Jan 1, 2025
Shires Equity Management, LLC Organization, Denison, TX LLC 5% Or Greater Indirect Ownership Interest Jul 28, 2025 6.3%
5R Real Estate Investments, LLC Organization, Plano, TX LLC 5% Or Greater Indirect Ownership Interest Jul 28, 2025 6.3%
Nobis Rehabilitation Holdings, LLC Organization, Lucas, TX LLC 5% Or Greater Indirect Ownership Interest Jul 28, 2025 100%
Nobis Rehabilitation Partners, LLC Organization, Lucas, TX LLC Operational/Managerial Control Jun 3, 2022
Stacie Goyne Individual W-2 Managing EmployeeCeo Jun 3, 2022
Nobis Hospital Investments, LLC Organization, Lucas, TX LLC 5% Or Greater Indirect Ownership Interest Jul 28, 2025 100%
Karen Macy Schepis Individual Corporate DirectorCorporate Director of Compliance May 2, 2023
Jerry Huggler Individual 5% Or Greater Indirect Ownership Interest Jul 28, 2025 6.87%
Margie Crawley Individual Corporate DirectorCorporate Director of Rev Cycle May 2, 2023
NKD Rehab, LLC Organization, Lucas, TX LLC 5% Or Greater Direct Ownership Interest Jun 3, 2022 100%
Shavelt Management Investors, LLC Organization, Dallas, TX LLC 5% Or Greater Indirect Ownership Interest Jul 28, 2025 9.19%

Facilities with the same owner 15

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

View all 15

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.

Affiliated clinicians 6

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": "1581984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1740813740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 CENTURY PKWY STE 220",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750138135",
            "telephone_number": "469-640-6503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10240 BROADWAY EXTENSION",
            "address_2": "STE. 320",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731147311",
            "telephone_number": "469-640-6503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OKLAHOMA CITY REHABILITATION HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-18",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "NIXON",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "469-640-6503"
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "CMS HIH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "7500 Security Blvd",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212441849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.