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Northeastern Oklahoma Community Health Centers, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Westville, OK

NPI 1821390402 · NPPES record last updated Dec 4, 2023

Key facts

NPI
1821390402
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, INC
Practice address
1779 Buffington Rd
Westville, OK 74965-7353
Phone
(918) 723-3997
Fax
(918) 723-3889
NPI assigned
Dec 2, 2010
Organization subpart
No

Authorized official

Name
Scott Rosenthal
Title
Ceo
Phone
(918) 772-3390

Owners & managing parties with NPI records 12

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

Owned or controlled facilities with NPI records 4

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

Other NPIs on the same Medicare enrollment 13

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

Other NPIs with the same Medicare PAC ID 12

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

Corporate family (same tax ID) 15

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

Facilities with the same owner 4

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

Practitioners 53

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

View all 53

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D2025417Westville Family Medicine
1779 Buffington Rd, Westville, OK 74965		Certificate of waiverJun 7, 2027

Medicare participation

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

Federally qualified health center certification: CCN 371869

Legal name
NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, INC
Doing business as
NEOHEALTH WESTVILLE FAMILY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 3, 2011
Last certification
Jun 3, 2011
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Dec 3, 2001 in OK
Enrollment address
1779 Buffington Rd
Westville, OK 74965-7353

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Luann Hudson
Individual 		Corporate Officer
Board Member		 Jun 19, 2019
Joann Bradley
Individual 		Corporate Officer
Board Member		 Dec 1, 2011
Scott Rosenthal
Individual 		Contracted Managing Employee
Ceo		 Dec 1, 2012
Corporate Director
Ceo		 Dec 1, 2012 100%
Joan Foster
Individual 		Corporate Director Mar 31, 2009
Northeastern Oklahoma Community Health Centers, Inc
Organization · Westville, OK
Non-profit 		Operational/Managerial Control Sep 1, 2010
Courtney Hamby
Individual 		Corporate Officer
Board Member		 Jun 1, 2016
Timothy M Booth
Individual 		Corporate Officer
Board Member		 Sep 1, 2012
Josh Stafford
Individual 		Corporate Officer
Board Member		 Dec 1, 2014
Beverly Runnels
Individual 		Corporate Officer
Board Member		 Sep 27, 2011
Anthony Ward
Individual 		Corporate Officer
Board Member		 Dec 27, 2018
Trena Payton
Individual 		Corporate Officer
Board Member		 Jul 28, 2016

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Neohealth Tahlequah Health Center
Tahlequah, OK · CCN 371867		 Federally qualified health center Operational/Managerial Control Jan 1, 2011
Neohealth OB/GYN
Tahlequah, OK · CCN 371868		 Federally qualified health center Operational/Managerial Control Jan 1, 2011
Neohealth Tahlequah Primary Care
Tahlequah, OK · CCN 371967		 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2012
Pryor Family Medical Center
Pryor, OK · CCN 371980		 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2012

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031104000417 OK Part B Supplier - Clinic/Group Practice 3678482635 Receives reassigned benefits from 70 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Westville, OK; Tahlequah, OK; Salina, OK; Pryor, OK; Muskogee, OK; Hulbert, OK
O20110503000828 OK Part a Provider - Federally Qualified Health Center (FQHC) 3678482635 Practice locations: Westville, OK

National Provider Directory

Tax ID family
NE Ok Comm HLTH Ctr Inc (16 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

1779 Buffington Rd
Westville, OK 74965-7353

Mailing address

PO Box 751
Hulbert, OK 74441-0751
Phone (918) 772-3390

Other identifiers

IdentifierTypeStateIssuer
200006960IMedicaidOK

Other names

  • NeoHealth Doing business as

Other providers in Westville, OK

All providers in Westville, OK · Federally Qualified Health Center (FQHC) in Oklahoma

Sources for this page

Verify at the official NPI Registry.