NPIMap

Organization Active NPI

Stillwater Medical Center Authority

  • Internal Medicine Physician
  • Tonkawa, OK
National Provider Identifier
1871320499
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
STILLWATER MEDICAL CENTER AUTHORITY
Doing business as
Stillwater Medical Clinic of Tonkawa
Practice address
105 E Grand Ave
Tonkawa, OK 74653-3503
Phone
(580) 308-3080
Fax
(833) 973-4377
NPI assigned
Sep 17, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Authorized official

Name
Robert Alan Lovelace
Title
Cfo
Phone
(405) 742-5729

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

105 E Grand Ave
Tonkawa, OK 74653-3503

Mailing address

PO Box 802738
Kansas City, MO 64180-2738
Phone (405) 742-5300

Other names 1

  • Stillwater Medical Clinic of Tonkawa Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040525001304 OK Part B Supplier - Clinic/Group Practice 2365353794 Receives reassigned benefits from 242 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stillwater, OK; Tonkawa, OK; Morrison, OK; Blackwell, OK; Chandler, OK; Cushing, OK; Enid, OK; Fairfax, OK…

Other NPIs on the same Medicare enrollment 3

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D2309953Stillwater Medical Clinic of Tonkawa105 E Grand Ave, Tonkawa, OK 74653Certificate of waiverAug 22, 2026

National Provider Directory

National Provider Directory
Tax ID family
Cimarron Medical Supply28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

Locations

105 E Grand Ave
Tonkawa, OK 74653
Phone (580) 308-3080

NPI Registry JSON

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

{
    "created_epoch": "1726531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726531200000",
    "number": "1871320499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 802738",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641802738",
            "telephone_number": "405-742-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E GRAND AVE",
            "city": "TONKAWA",
            "state": "OK",
            "postal_code": "746533503",
            "telephone_number": "580-308-3080",
            "fax_number": "833-973-4377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILLWATER MEDICAL CENTER AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-17",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A",
        "authorized_official_last_name": "LOVELACE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "405-742-5729"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stillwater Medical Clinic of Tonkawa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tonkawa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.