NPIMap

Rural Wellness Fairfax Inc

Organization Active NPI Rural Health Clinic/Center · Pawnee, OK

NPI 1982233656 · NPPES record last updated Oct 21, 2024

Key facts

NPI
1982233656
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
RURAL WELLNESS FAIRFAX INC
Practice address
535 6TH St
Pawnee, OK 74058-2542
Phone
(918) 762-3942
Fax
(918) 762-4675
NPI assigned
Apr 5, 2020
Organization subpart
No

Authorized official

Name
Elizabeth J Pusey
Title
President
Phone
(949) 645-2321

Owners & managing parties with NPI records 1

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

Other NPIs with the same Medicare PAC ID 3

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

Corporate family (same tax ID) 2

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

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

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Facilities with the same owner 7

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

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in OK

Rural health clinic certification: CCN 373471

Legal name
RURAL WELLNESS FAIRFAX INC
Doing business as
RURAL WELLNESS PAWNEE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 11, 2013
Last certification
Jan 13, 2025
Ownership / control type
1B
Most recent change of ownership
Mar 20, 2020 (2 total)
Organization structure
Corporation · Proprietary
Incorporated
Dec 10, 2019 in OK
Enrollment address
535 6TH St
Pawnee, OK 74058-2542
Related CCNs
371318

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Elizabeth J Pusey
Individual 		5% Or Greater Indirect Ownership Interest
President		 Mar 20, 2020 100%
Rural Wellness Healthcare LLC
Organization · Edmond, OK
LLC 		5% Or Greater Direct Ownership Interest Nov 1, 2021 100%
Hunter Thoms
Individual 		Contracted Managing Employee
Ad;		 Oct 1, 2020
James I Graham
Individual 		Operational/Managerial Control
Director		 Nov 1, 2021 100%
Charlie Cartwright
Individual 		Operational/Managerial Control
Administrator		 Nov 1, 2021 100%
Debi Barnard
Individual 		Operational/Managerial Control
Director		 Nov 1, 2021 100%
Rural Hospital Acquisition LLC
Organization · Oklahoma City, OK
LLC, Owned by another organization or individual 		5% Or Greater Security Interest Feb 6, 2023 100%
FPFX Business Solutions, Inc.
Organization · Oklahoma City, OK
Management services company 		Operational/Managerial Control Feb 6, 2023 100%
Ned Williams
Individual 		Operational/Managerial Control
Administrator		 Nov 1, 2021 100%

Change-of-ownership history

DateEventCounterparty
Mar 20, 2020 Change of Ownership
This provider was the buyer		 The Pawnee Clinic
CCN 373471 · OK · NPI 1598039620

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20200505002302 OK Part a Provider - Rural Health Clinic 3678904752 Practice locations: Pawnee, OK

National Provider Directory

Tax ID family
Rural Wellness Fairfax Inc (3 organizations share this tax ID)

Locations

535 6th St
Pawnee, OK 74058
Phone (918) 240-4073

Interoperability endpoints

  • Direct secure messaging: rwf.rhc2@rhc2fairfax.medalliesdirect.net
  • Direct secure messaging: crystalmccarty@rhc2fairfax.medalliesdirect.net
  • Direct secure messaging: geneevans@rhc2fairfax.medalliesdirect.net

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

535 6TH St
Pawnee, OK 74058-2542

Mailing address

2524 N Broadway
Edmond, OK 73034-4172
Phone (949) 322-4337

Other names

  • Rural Wellness Pawnee Clinic Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
Direct Messaging Address RWF.RHC2@rhc2fairfax.medalliesdirect.net

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 21, 2024.

{
    "created_epoch": "1586044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729468800000",
    "number": "1982233656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2524 N BROADWAY",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730344172",
            "telephone_number": "949-322-4337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 6TH ST",
            "city": "PAWNEE",
            "state": "OK",
            "postal_code": "740582542",
            "telephone_number": "918-762-3942",
            "fax_number": "918-762-4675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL WELLNESS FAIRFAX INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-05",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A",
        "authorized_official_last_name": "PUSEY",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-645-2321"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "RWF.RHC2@rhc2fairfax.medalliesdirect.net",
            "affiliation": "N",
            "address_1": "2308 W Highway 66",
            "city": "Stroud",
            "state": "OK",
            "country_code": "US",
            "postal_code": "740796729",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Rural Wellness Pawnee Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pawnee, OK

All providers in Pawnee, OK · Rural Health Clinic/Center in Oklahoma

Sources for this page

Verify at the official NPI Registry.