NPIMap

Prague Healthcare Authority

Organization Active NPI Critical Access Hospital · Prague, OK

NPI 1750527768 · NPPES record last updated Dec 27, 2023

Key facts

NPI
1750527768
Entity type
Organization (NPI type 2)
Primary specialty
Critical Access Hospital 282NC0060X
License
2164 (OK)
Legal business name
PRAGUE HEALTHCARE AUTHORITY
Practice address
1322 Klabzuba Avenue
Prague, OK 74864
Phone
(405) 567-4922
Fax
(405) 567-4290
NPI assigned
Dec 22, 2008
Organization subpart
No

Authorized official

Name
Dianne M Dyer
Title
Revenue Cycle Manager
Phone
(405) 567-4922

Owners & managing parties with NPI records 3

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

Owned or controlled facilities with NPI records 2

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

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 3

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

Corporate family (same tax ID) 2

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 4

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

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 30

Affiliated clinicians 10

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

Medicare Care Compare: Hospital

Listed as
Prague Regional Memorial Hospital CCN 371301
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in OK

Hospital certification: CCN 371301

Legal name
PRAGUE HEALTHCARE AUTHORITY
Doing business as
PRAGUE REGIONAL MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Mar 1, 1999
Last certification
Jun 21, 2024
Beds
25
Ownership / control type
Local
Most recent change of ownership
Jan 1, 2021 (7 total)
Organization structure
Other · Non-profit
Enrollment address
1322 Klabzuba Ave
Prague, OK 74864-4900
Main/Primary Hospital Location

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
Shayleen Fipps
Individual 		Corporate Officer
Ceo		 Mar 1, 2025 100%
Operational/Managerial Control
Ceo		 Jan 1, 2020 100%
Cohesive Healthcare Management and Consulting LLC
Organization · Shawnee, OK
Management services company 		Operational/Managerial Control Jan 1, 2021
Prague Healthcare Authority
Organization · Prague, OK 		5% Or Greater Direct Ownership Interest Jan 1, 2021 100%

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Prague Memorial Regional Hospital
Prague, OK · CCN 37Z301		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2021
Prague Community Hospital - Prague Family Clinic
Prague, OK · CCN 373462		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2021

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20210318002639 OK Part a Provider - Critical Access Hospital 8123435187 Receives reassigned benefits from 16 practitioners
Practice locations: Prague, OK
O20210524002299 OK Part B Supplier - Clinic/Group Practice 8123435187 Receives reassigned benefits from 33 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Prague, OK

National Provider Directory

Tax ID family
Prague Healthcare Authority (3 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 2164 OK Yes

Addresses

Primary practice location

1322 Klabzuba Avenue
Prague, OK 74864

Mailing address

PO Drawer S
1322 Klabzuba Avenue
Prague, OK 74864-1090
Phone (405) 567-4922

Other identifiers

IdentifierTypeStateIssuer
200231400BMedicaidOK

Other names

  • Prague Memorial Regional Hospital Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
Direct Messaging Address ehr-direct@praguehospital.hin.us Direct

Other providers in Prague, OK

All providers in Prague, OK · Critical Access Hospital in Oklahoma

Sources for this page

Verify at the official NPI Registry.