NPIMap

Organization Active NPI

Mercy Hospital Tishomingo, Inc

  • Emergency Medicine Physician
  • Tishomingo, OK
National Provider Identifier
1972809002
Registry record updated Oct 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
MERCY HOSPITAL TISHOMINGO, INC
Practice address
1000 S Byrd St
Tishomingo, OK 73460-3265
Phone
(580) 371-2327
NPI assigned
Feb 8, 2011
Last updated
Oct 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2018

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

Authorized official

Name
Tracy Enloe
Title
Cfo
Phone
(405) 752-3161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

1000 S Byrd St
Tishomingo, OK 73460-3265

Mailing address

1000 S Byrd St
Tishomingo, OK 73460-3265

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180507002045 OK Part B Supplier - Clinic/Group Practice 1557542032 Receives reassigned benefits from 83 practitioners
1 other NPI on this enrollment
Practice locations: Tishomingo, OK

Other NPIs with the same Medicare PAC ID 2

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.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 83

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 83

NPI Registry JSON

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

{
    "created_epoch": "1297123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539648000000",
    "number": "1972809002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 S BYRD ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734603265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S BYRD ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734603265",
            "telephone_number": "580-371-2327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL TISHOMINGO, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-08",
        "last_updated": "2018-10-16",
        "status": "A",
        "authorized_official_last_name": "ENLOE",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "405-752-3161"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tishomingo, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.