NPIMap

Organization Active NPI

Central Oklahoma Family Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Konawa, OK
National Provider Identifier
1831291293
Registry record updated Jan 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC.
Practice address
527 West 3Rd St
Konawa, OK 74849
Phone
(580) 925-3286
Fax
(580) 925-2362
NPI assigned
Sep 5, 2006
Last updated
Jan 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2022

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

Authorized official

Name
Brenda Ware
Title
Ceo
Phone
(580) 925-3286

Specialties & licenses 1

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

Addresses

Primary practice location

527 West 3Rd St
Konawa, OK 74849

Mailing address

527 West 3Rd Street
Konawa, OK 74849
Phone (580) 925-3286

Other names 1

  • Central Oklahoma Family Med Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040722001013 OK Part B Supplier - Clinic/Group Practice 9931189685 Receives reassigned benefits from 68 practitioners
15 other NPIs on this enrollment
Practice locations: Seminole, OK; Stratford,, OK; Konawa, OK; Ada, OK

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory

Locations

304 N Monte Vista St
Ada, OK 74820
Phone (405) 584-4078

905 Colony Dr
#A
Ada, OK 74820

2249 Boren Blvd
Ste A
Seminole, OK 74868

2403 W Wrangler Blvd
Seminole, OK 74868
Phone (405) 382-4939

Ownership & related parties

All facility ownership & control disclosures 10

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

FacilityTypeRoleSince
Central Oklahoma Family Medical Center IncAda, OK, CCN 371936 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 1986
Central Oklahoma Family Medical Center IncStratford, OK, CCN 371948 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2019
Central Oklahoma Family Medical Center IncAda, OK, CCN 371965 Federally qualified health center Operational/Managerial Control (100%) Mar 25, 2002
Central Oklahoma Family Medical Center IncAda, OK, CCN 371969 Federally qualified health center Operational/Managerial Control Sep 1, 2021
Central Oklahoma Family Medical Center IncAda, OK, CCN 371972 Federally qualified health center Operational/Managerial Control Sep 1, 2021
Central Oklahoma Family Medical Center IncAda, OK, CCN 371976 Federally qualified health center Operational/Managerial Control Jan 11, 2022
Central Oklahoma Family Medical Center IncSeminole, OK, CCN 371977 Federally qualified health center Operational/Managerial Control May 3, 2022
Central Oklahoma Family Medical Center IncAda, OK, CCN 371978 Federally qualified health center Operational/Managerial Control Jun 1, 2022
Central Oklahoma Family Medical Center IncAda, OK, CCN 371979 Federally qualified health center Operational/Managerial Control Feb 1, 2022
Central Oklahoma Family Medical Center IncSeminole, OK, CCN 371005 Federally qualified health center Operational/Managerial Control (100%) Mar 25, 2002

Owned or controlled facilities with NPI records 10

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

Practitioners & affiliated clinicians

Practitioners 71

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 71

NPI Registry JSON

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643587200000",
    "number": "1831291293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 WEST 3RD STREET",
            "city": "KONAWA",
            "state": "OK",
            "postal_code": "74849",
            "telephone_number": "580-925-3286",
            "fax_number": "580-925-9149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 WEST 3RD ST",
            "city": "KONAWA",
            "state": "OK",
            "postal_code": "74849",
            "telephone_number": "580-925-3286",
            "fax_number": "580-925-2362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A",
        "authorized_official_last_name": "WARE",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-925-3286"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Oklahoma Family Med Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Central Oklahoma Family Med Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Konawa, OK

Sources for this page

Verify at the official NPI Registry.