NPIMap

Organization Active NPI

Pushmataha Family Medical Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Clayton, OK
National Provider Identifier
1891882676
Registry record updated Nov 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PUSHMATAHA FAMILY MEDICAL CENTER, INC
Practice address
109 Stanley Road
Clayton, OK 74536
Phone
(918) 569-4143
Fax
(918) 569-7343
NPI assigned
Oct 5, 2006
Last updated
Nov 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2025

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

Authorized official

Name
Angela Renee Batton, RN
Title
Ceo
Phone
(918) 917-9999

Specialties & licenses 2

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

Addresses

Primary practice location

109 Stanley Road
Clayton, OK 74536

Mailing address

PO Box 219
Clayton, OK 74536-0219
Phone (918) 917-9999

Other identifiers 3

IdentifierTypeStateIssuer
200072150BMedicaidOK
37D0669928OtherOKCLIA
622460OtherOKUNIVERSAL DATA SYSTEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20081114000464 OK Part B Supplier - Clinic/Group Practice 9537189261 Receives reassigned benefits from 14 practitioners
Practice locations: Boswell, OK; Clayton, OK
O20111012000715 OK Part A Provider - Federally Qualified Health Center (FQHC) 9537189261 Practice locations: Clayton, OK
O20160701000430 OK Part A Provider - Federally Qualified Health Center (FQHC) 9537189261 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Boswell, OK

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1891882676. Details of each certification follow.

Federally qualified health center certification: CCN 371839

Legal name
PUSHMATAHA FAMILY MEDICAL CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 26, 2006
Last certification
Jan 26, 2006
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 10, 2004 in OK
Enrollment address
1020 N Lawson Boulevard
Clayton, OK 74536-0219

Federally qualified health center certification: CCN 371915

Legal name
PUSHMATAHA FAMILY MEDICAL CENTER, INC
Doing business as
PUSHMATAHA FAMILY MEDICAL CENTER OF BOSWELL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 8, 2016
Last certification
Apr 8, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 10, 2004 in OK
Enrollment address
415 6TH St
Boswell, OK 74727-2072

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 1

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
37D0669928Pushmataha Family Medical Center1020 N Lawson Blvd, Clayton, OK 74536AccreditationJun 23, 2028

National Provider Directory

National Provider Directory

Locations

415 6th St
Boswell, OK 74727
Phone (580) 566-2530

415 6th St
#149
Boswell, OK 74727

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Angela R Batton Individual Corporate OfficerCeo Sep 23, 2011
Operational/Managerial ControlCeo Jul 8, 2010
Corporate OfficerCeo Sep 2, 2015
Tammy Stamps Individual Corporate OfficerBoard Member Oct 9, 2019
Corporate DirectorBoard Member Oct 9, 2019
Thomas C Lucas Individual Corporate DirectorBoard Member Feb 20, 2014
Dawn Buchanan Individual Corporate Officer Oct 9, 2019
Corporate DirectorBoard Member Oct 9, 2019
Dianna J Ben Individual Corporate DirectorBoard Member Mar 30, 2010
Janet R Maddox Individual Corporate DirectorBoard Member Jan 1, 2006
Alaina D Bray Individual Corporate Officer Jul 1, 2014
Corporate OfficerCfo Sep 2, 2015
Crystal F Frizzell Individual Corporate DirectorBoard Member May 18, 2010
Amanda L Vandenburg Individual Corporate DirectorMedical Director Feb 23, 2023
Cody Brown Individual Corporate Officer Jun 15, 2023
Jon Hotubbee Individual Corporate OfficerBoard Member Jul 5, 2022
Helen Bryan Individual Corporate OfficerSecretary Nov 16, 2021
Melissa Robinson Individual Corporate DirectorBoard Member Jun 24, 2021
James Smith Individual Corporate OfficerBoard Member Jul 5, 2022
Keri J Crossland Individual W-2 Managing EmployeeBilling Manager Sep 2, 2015

Owners & managing parties with NPI records 1

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763337600000",
    "number": "1891882676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 219",
            "city": "CLAYTON",
            "state": "OK",
            "postal_code": "745360219",
            "telephone_number": "918-917-9999",
            "fax_number": "918-569-7343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 STANLEY ROAD",
            "city": "CLAYTON",
            "state": "OK",
            "postal_code": "74536",
            "telephone_number": "918-569-4143",
            "fax_number": "918-569-7343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUSHMATAHA FAMILY MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2025-11-17",
        "certification_date": "2025-11-17",
        "status": "A",
        "authorized_official_last_name": "BATTON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-917-9999",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "OK",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200072150B",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "37D0669928",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERSAL DATA SYSTEM",
            "identifier": "622460",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clayton, OK

Sources for this page

Verify at the official NPI Registry.