NPIMap

Organization Active NPI

Integris Hospice, Inc

  • Community Based Hospice Care Agency
  • Oklahoma City, OK
National Provider Identifier
1912926965
Registry record updated May 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
4002 Issued in OK
Legal business name
INTEGRIS HOSPICE, INC
Practice address
5710 NW 130TH St
Oklahoma City, OK 73142-6003
Phone
(405) 848-8884
NPI assigned
Jul 19, 2006
Last updated
May 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2019

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

Authorized official

Name
Brent Davis
Title
Vice President
Phone
(405) 949-3774

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 4002 OK Primary

Addresses

Primary practice location

5710 NW 130TH St
Oklahoma City, OK 73142-6003

Mailing address

PO Box 960514
Oklahoma City, OK 73196-0514
Phone (405) 848-8884

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120511000233 OK Part A Provider - Hospice 4688720238 Practice locations: Oklahoma City, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912926965. Details of each certification follow.

Hospice certification: CCN 371513

Legal name
INTEGRIS HOSPICE, INC.
Doing business as
INTEGRIS HOSPICE HOUSE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 1, 1991
Last certification
Sep 15, 2020
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 14, 1990 in OK
Enrollment address
5710 NW 130TH St
Ste 100
Oklahoma City, OK 73142-6003

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Integris Hospice HouseCCN 371513 · All quality measures
Ownership
For-Profit
Certified
Apr 1, 1991
Medicare certification status
ActiveFrom the Provider of Services file

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
37D0877700Integris Hospice5710 NW 130TH Street, Oklahoma City, OK 73142Certificate of waiverOct 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Integris Hospice Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

5710 NW 130th St
Oklahoma City, OK 73142
Phone (405) 848-8884

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Linda Merkey Individual Corporate DirectorBoard Member Jan 1, 1998
Ashley N Muckala Individual Corporate Director Jul 1, 2023
Donna M Wallace Individual Corporate Officer Sep 1, 2023
W-2 Managing Employee Sep 1, 2023
Lydia Welch Individual Corporate Director Jul 1, 2023
Casey Ahlden Individual Corporate Director Jul 1, 2022
Brad Ferguson Individual Corporate DirectorBoard Member Jan 1, 2008
Integris Hospice, Inc. Organization, Oklahoma City, OK Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 14, 1990 100%
Melinda Warren Individual Corporate DirectorBoard Member Jan 1, 2006
Michelle Powers Individual Corporate Director Jul 1, 2022
Alison Fink Individual Corporate Director Jul 1, 2022
Avilla Williams Individual Corporate Director Jul 1, 2022
Timothy Pehrson Individual Corporate Director Jul 1, 2022

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 7

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": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558569600000",
    "number": "1912926965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 960514",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731960514",
            "telephone_number": "405-848-8884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5710 NW 130TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731426003",
            "telephone_number": "405-848-8884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRIS HOSPICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2019-05-23",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "405-949-3774"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "OK",
            "license": "4002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.