NPIMap

Organization Active NPI

Prague Healthcare Authority

Doing business as Prague Memorial Regional Hospital

  • Critical Access Hospital
  • Prague, OK
National Provider Identifier
1750527768
Registry record updated Dec 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
2164 Issued in OK
Legal business name
PRAGUE HEALTHCARE AUTHORITY
Doing business as
Prague Memorial Regional Hospital
Practice address
1322 Klabzuba Avenue
Prague, OK 74864
Phone
(405) 567-4922
Fax
(405) 567-4290
NPI assigned
Dec 22, 2008
Last updated
Dec 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2023

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

Authorized official

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

Specialties & licenses 1

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

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 names 1

  • Prague Memorial Regional Hospital Doing business as

Electronic endpoints 1

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

Medicare participation

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

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750527768. Details of each certification follow.

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
OtherNon-profit
Enrollment address
1322 Klabzuba Ave
Prague, OK 74864-4900
Main/Primary Hospital Location

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

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 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Prague Regional Memorial HospitalCCN 371301 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Prague Healthcare Authority3 organizations share this tax ID, including this one

Other organizations with this 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.

Interoperability endpoints

  • Direct secure messaging: ehr-direct@praguehospital.hin.us

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
Shayleen Fipps Individual Corporate OfficerCeo Mar 1, 2025 100%
Operational/Managerial ControlCeo 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%

Owners & managing parties with NPI records 3

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

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 HospitalPrague, OK, CCN 37Z301 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2021
Prague Community Hospital - Prague Family ClinicPrague, OK, CCN 373462 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2021

Owned or controlled facilities with NPI records 2

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

Practitioners 30

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.

View all 30

Affiliated clinicians 10

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": "1229904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703635200000",
    "number": "1750527768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO DRAWER S",
            "address_2": "1322 KLABZUBA AVENUE",
            "city": "PRAGUE",
            "state": "OK",
            "postal_code": "748641090",
            "telephone_number": "405-567-4922",
            "fax_number": "405-567-4290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1322 KLABZUBA AVENUE",
            "city": "PRAGUE",
            "state": "OK",
            "postal_code": "74864",
            "telephone_number": "405-567-4922",
            "fax_number": "405-567-4290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAGUE HEALTHCARE AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-22",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A",
        "authorized_official_last_name": "DYER",
        "authorized_official_first_name": "DIANNE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "405-567-4922"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "OK",
            "license": "2164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ehr-direct@praguehospital.hin.us",
            "affiliation": "N",
            "endpointDescription": "Prague Regional Memorial Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1322 Klabzuba Avenue",
            "city": "Prague",
            "state": "OK",
            "country_code": "US",
            "postal_code": "74864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Prague Memorial Regional Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prague, OK

Sources for this page

Verify at the official NPI Registry.