NPIMap

Organization Active NPI

Shawnee Medical Center Clinic, Inc

Doing business as SSM Health Specialty Clinic Ada

  • Cardiovascular Disease Physician
  • Ada, OK
National Provider Identifier
1841832755
Registry record updated Oct 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
SHAWNEE MEDICAL CENTER CLINIC, INC
Doing business as
SSM Health Specialty Clinic Ada
Practice address
3012 Arlington St
Ada, OK 74820-3073
Phone
(580) 272-0715
Fax
(580) 272-0772
NPI assigned
Oct 11, 2019
Last updated
Oct 11, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
SSM HEALTH CARE OF OKLAHOMA, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 11, 2019

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

Authorized official

Name
Crystal L Pena
Title
Provider Enrollment/Ins Credential
Phone
(405) 272-7452

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X
Cardiovascular Disease Physician 207RC0000X Primary
Gastroenterology Physician 207RG0100X
Pulmonary Disease Physician 207RP1001X
Rheumatology Physician 207RR0500X

Addresses

Primary practice location

3012 Arlington St
Ada, OK 74820-3073

Mailing address

3012 Arlington St
Ada, OK 74820-3073
Phone (580) 272-0715

Other names 1

  • SSM Health Specialty Clinic Ada Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Shawnee Medical Center Clinic Inc13 organizations share this tax ID, including this one
Part of
Sah Op CLN

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1570752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570752000000",
    "number": "1841832755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3012 ARLINGTON ST",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748203073",
            "telephone_number": "580-272-0715",
            "fax_number": "580-272-0772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3012 ARLINGTON ST",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748203073",
            "telephone_number": "580-272-0715",
            "fax_number": "580-272-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWNEE MEDICAL CENTER CLINIC, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM HEALTH CARE OF OKLAHOMA, INC",
        "enumeration_date": "2019-10-11",
        "last_updated": "2019-10-11",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT/INS CREDENTIAL",
        "authorized_official_telephone_number": "405-272-7452"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Specialty Clinic Ada",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ada, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.