Premise Health of Oklahoma Medical, P.C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PREMISE HEALTH OF OKLAHOMA MEDICAL, P.C

Doing business as

Goodyear Family Medical Center

Practice address

901 SW Goodyear Blvd
Lawton, OK 73505-9755

Phone

(580) 510-6361

Fax

(580) 531-5779

NPI assigned

Nov 9, 2006

Last updated

Oct 13, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jon Leizman

Title

President

Phone

(216) 479-9063

Specialties & licenses 1

Addresses

Other names 1

• Goodyear Family Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

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

• Premise Health of Oklahoma Medical PC

  dba Michelin Family Heatlh Center-Ardmore

  • Clinic/Center
  • Ardmore, OK
  • NPI 1740540327

  O20050322000100

  Same enrollment
• Premise Health of Oklahoma Medical PC

  dba the Doc Powered by Premise Health

  • Multi-Specialty Clinic/Center
  • Oklahoma City, OK
  • NPI 1902475957

  O20050322000100

  Same enrollment
• Premise Health of Oklahoma Medical, P.C

  dba Employees' Healthcare Center of Stillwater

  • Family Medicine Physician
  • Stillwater, OK
  • NPI 1427112648

  O20050322000100

  Same enrollment

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1841360336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 120",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 SW GOODYEAR BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735059755",
            "telephone_number": "580-510-6361",
            "fax_number": "580-531-5779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF OKLAHOMA MEDICAL, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goodyear Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Goodyear Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dominique Lamar Pratt, ATC
• Kristi Dawn Pratt, APRN-CNP
• Ramon O Pratts, M.D.
• Prehab Physical Therapy Clinic Inc.
• Premier Behavorial Health
• Belinda Price
• Jordan Renee Price, DO
• Ronnie Price
• Tommie Lee Price, LADC
• Tracy Lashun Price

• Family Medicine Physician in Lawton, OK
• Providers in Lawton, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.