NPIMap

Organization Active NPI

Parkside, Inc.

  • Psychiatric Hospital
  • Tulsa, OK
National Provider Identifier
1851327464
Registry record updated Aug 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
2261 Issued in OK
Legal business name
PARKSIDE, INC.
Practice address
1620 E 12TH St
Tulsa, OK 74120-5407
Phone
(918) 582-2131
NPI assigned
Jun 24, 2006
Last updated
Aug 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2026

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

Authorized official

Name
Mrs. Saunya D Moore
Title
Cfo
Phone
(918) 582-2131

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 2261 OK
Adolescent and Children Mental Health Clinic/Center 261QM0855X 2261 OK
Psychiatric Hospital 283Q00000X 2261 OK Primary

Addresses

Primary practice location

1620 E 12TH St
Tulsa, OK 74120-5407

Mailing address

1620 E 12TH St
Tulsa, OK 74120-5407
Phone (918) 582-2131

Other identifiers 4

IdentifierTypeStateIssuer
100738360BMedicaidOK
A00174120OtherOKCHAMPUS
000374005-001OtherOKBC/BS
100738360CMedicaidOK

Other names 1

  • Parkside Outpatient Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040312000336 OK Part B Supplier - Clinic/Group Practice 5496644049 Receives reassigned benefits from 23 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tulsa, OK
O20080616000486 OK Part A Provider - Hospital 5496644049 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tulsa, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851327464. Details of each certification follow.

Hospital certification: CCN 374021

Legal name
PARKSIDE, INC.
Doing business as
PARKSIDE PSYCHIATRIC HOSPITAL & CLINIC
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
May 24, 2001
Last certification
Sep 20, 2024
Beds
120
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Dec 27, 1991 in OK
Enrollment address
1619 E 13TH St
Parkside, Inc.
Tulsa, OK 74120-5407
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Other NPIs on the same Medicare enrollment 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Parkside, IncCCN 374021 · All quality measures
Type
Psychiatric
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Parkside Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
James Dean Serratt Individual Corporate OfficerCeo Jun 20, 2022
Corporate DirectorExecutive Director of Administra Jan 1, 2023
W-2 Managing EmployeeCeo Jun 20, 2022
Christine Peterson Individual Other Mar 31, 2022
William Sachau Individual OtherDirector of Business Development Feb 10, 2007
Parkside, Inc. Organization, Tulsa, OK Non-profit Operational/Managerial Control Dec 27, 1991
Allan Polhill Individual Corporate OfficerCfo Feb 28, 2022
Corporate DirectorDirector of Revenue Cycle Jan 1, 2023
W-2 Managing EmployeeCfo Mar 31, 2022

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786320000000",
    "number": "1851327464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 E 12TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741205407",
            "telephone_number": "918-582-2131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 E 12TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741205407",
            "telephone_number": "918-582-2131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKSIDE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2026-08-10",
        "certification_date": "2026-08-10",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "SAUNYA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "918-582-2131",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "OK",
            "license": "2261",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "OK",
            "license": "2261",
            "primary": false
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "OK",
            "license": "2261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100738360B",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "A00174120",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "000374005-001",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100738360C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkside Outpatient",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.