NPIMap

Organization Active NPI

Citizen Potawatomi Nation

Doing business as Citizen Potawatomi Nation West Clinic

  • Federally Qualified Health Center (FQHC)
  • Shawnee, OK
National Provider Identifier
1881981744
Registry record updated Feb 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CITIZEN POTAWATOMI NATION
Doing business as
Citizen Potawatomi Nation West Clinic
Practice address
781 Grand Casino Blvd
Shawnee, OK 74804-1005
Phone
(405) 964-5770
Fax
(405) 964-5785
NPI assigned
Jun 29, 2011
Last updated
Feb 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2025

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

Authorized official

Name
Mr. Chris Skillings
Title
Director of Health Services
Phone
(405) 964-5770

Specialties & licenses 1

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

Addresses

Primary practice location

781 Grand Casino Blvd
Shawnee, OK 74804-1005

Mailing address

781 Grand Casino Blvd
Shawnee, OK 74804-1005
Phone (405) 964-5770

Other identifiers 3

IdentifierTypeStateIssuer
100211300EMedicaidOK
100244300FMedicaidOK
100244300GMedicaidOK

Other names 1

  • Citizen Potawatomi Nation West Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120105000559 OK Part A Provider - Federally Qualified Health Center (FQHC) 3375511488 Practice locations: Shawnee, OK
O20140123000876 TX Part B Supplier - Clinic/Group Practice 3375511488 Receives reassigned benefits from 53 practitioners
2 other NPIs on this enrollment
Practice locations: Shawnee, OK; Tecumseh, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881981744. Details of each certification follow.

Federally qualified health center certification: CCN 371877

Legal name
CITIZEN POTAWATOMI NATION
Doing business as
CITIZEN POTAWATOMI NATION WEST CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 14, 2012
Last certification
Feb 14, 2012
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
781 Grand Casino Blvd
Citizen Potawatomi Nation West Clinic
Shawnee, OK 74804-1005

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

1601 Gordon Cooper Dr
Shawnee, OK 74801
Phone (405) 275-9610

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Aubry Bennett Individual W-2 Managing EmployeeBusiness Office Coordinator Jan 1, 2022
Citizen Potawatomi Nation Organization, Shawnee, OK 5% Or Greater Direct Ownership Interest Aug 10, 2011 100%
John Barrett Individual Corporate Director Aug 10, 2011

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Citizen Potawatomi NationShawnee, OK, CCN 371825 Federally qualified health center Operational/Managerial Control (100%) Jul 29, 2010

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 54

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 54

NPI Registry JSON

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

{
    "created_epoch": "1309305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740700800000",
    "number": "1881981744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "781 GRAND CASINO BLVD",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041005",
            "telephone_number": "405-964-5770",
            "fax_number": "405-964-5783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "781 GRAND CASINO BLVD",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041005",
            "telephone_number": "405-964-5770",
            "fax_number": "405-964-5785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIZEN POTAWATOMI NATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-29",
        "last_updated": "2025-02-28",
        "certification_date": "2025-02-28",
        "status": "A",
        "authorized_official_last_name": "SKILLINGS",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "DIRECTOR OF HEALTH SERVICES",
        "authorized_official_telephone_number": "405-964-5770",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100211300E",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100244300F",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100244300G",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Citizen Potawatomi Nation West Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shawnee, OK

Sources for this page

Verify at the official NPI Registry.