NPIMap

Organization Active NPI

St John Sapulpa, Inc.

  • Critical Access Hospital
  • Sapulpa, OK
National Provider Identifier
1922076603
Registry record updated Jan 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
2310 Issued in OK
Legal business name
ST JOHN SAPULPA, INC.
Practice address
1004 E Bryan Ave
Sapulpa, OK 74066-4513
Phone
(918) 224-4280
Fax
(918) 224-6290
NPI assigned
Mar 9, 2006
Last updated
Jan 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2014

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

Authorized official

Name
Mr. David L. Phillips
Title
Coo
Phone
(918) 227-8601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 2310 OK Primary

Addresses

Primary practice location

1004 E Bryan Ave
Sapulpa, OK 74066-4513

Mailing address

PO Box 1368
Sapulpa, OK 74067-1368
Phone (918) 224-4280

Other identifiers 2

IdentifierTypeStateIssuer
100699550MedicaidOK
000370033001OtherOKBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081014000163 OK Part A Provider - Critical Access Hospital 6507850211 Practice locations: Sapulpa, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922076603. Details of each certification follow.

Hospital certification: CCN 371312

Legal name
ST JOHN SAPULPA INC
Doing business as
BARTLETT MEMORIAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Aug 10, 2000
Last certification
Dec 29, 2023
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Dec 26, 1956 in OK
Enrollment address
1004 E Bryan Ave
St John Sapulpa
Sapulpa, OK 74066-4513
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

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: Hospital

Medicare Care Compare
Listed as
Ascension St John SapulpaCCN 371312 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

1004 E Bryan Ave
Sapulpa, OK 74066
Phone (918) 224-4280

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Sheila Vancuren Individual Operational/Managerial ControlBoard Member Aug 1, 2025 10%
Catherine Gebetsberger Individual Operational/Managerial ControlBoard Member Aug 1, 2025 10%
Brian Mithcell Individual Operational/Managerial ControlBoard Member Aug 1, 2025 10%
St John Health Systems Inc Organization, Tulsa, OK Non-profit 5% Or Greater Direct Ownership Interest May 1, 2000 100%
Joshua Zachariah Vicena Individual Operational/Managerial ControlBoard Member Jan 1, 2024 10%
Mark Lawson Individual Operational/Managerial ControlBoard Member Aug 1, 2025 10%
Mark Clay Individual Corporate OfficerPresident Aug 1, 2025 10%
Lisa Ford Individual Operational/Managerial ControlBoard Member Aug 1, 2025 10%
Thomas Kimball Individual Operational/Managerial ControlBoard Member Aug 1, 2025 10%
Heather Turner Individual Operational/Managerial ControlBoard Member Aug 1, 2025 10%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 40

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 40

Affiliated clinicians 125

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 125

NPI Registry JSON

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390435200000",
    "number": "1922076603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1368",
            "city": "SAPULPA",
            "state": "OK",
            "postal_code": "740671368",
            "telephone_number": "918-224-4280",
            "fax_number": "918-224-6290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 E BRYAN AVE",
            "city": "SAPULPA",
            "state": "OK",
            "postal_code": "740664513",
            "telephone_number": "918-224-4280",
            "fax_number": "918-224-6290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHN SAPULPA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-09",
        "last_updated": "2014-01-23",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "918-227-8601",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "OK",
            "license": "2310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100699550",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000370033001",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sapulpa, OK

Sources for this page

Verify at the official NPI Registry.