NPIMap

Organization Active NPI

Variety Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Oklahoma City, OK
National Provider Identifier
1982939526
Registry record updated Feb 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VARIETY CARE, INC.
Practice address
500 SW 44TH St
Oklahoma City, OK 73109-3540
Phone
(405) 632-6688
Fax
(405) 235-5208
NPI assigned
Oct 15, 2009
Organization subpart
Yes
Parent organization
VARIETY CARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 26, 2020

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

Authorized official

Name
Tim Reddout
Title
Cfo
Phone
(405) 632-6688

Specialties & licenses 1

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

Addresses

Primary practice location

500 SW 44TH St
Oklahoma City, OK 73109-3540

Mailing address

3000 N Grand Blvd
Oklahoma City, OK 73107-1818
Phone (405) 632-6688

Other names 1

  • Variety Care Lafayette Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040105000467 OK Part B Supplier - Clinic/Group Practice 1557260007 Receives reassigned benefits from 135 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clinton, OK; Anadarko, OK; Yukon, OK; Oklahoma City, OK; Del City, OK; Edmond, OK; Fort Cobb, OK; Grandfield, OK…
O20091111000236 OK Part A Provider - Federally Qualified Health Center (FQHC) 1557260007 Practice locations: Oklahoma City, OK

Federally qualified health center certification: CCN 371857

Legal name
VARIETY CARE, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 13, 2009
Last certification
Nov 13, 2009
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jan 9, 1980 in OK
Enrollment address
500 SW 44TH St
Oklahoma City, OK 73109-3540

Other NPIs with the same Medicare PAC ID 22

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

View all 22

Other NPIs on the same Medicare enrollment 26

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 26

National Provider Directory

National Provider Directory
Tax ID family
Variety Care Inc26 organizations share this tax ID, including this one
Part of
Variety Care Inc

Other organizations with this tax ID 25

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

View all 25

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
Mariano Acuna Individual Corporate DirectorBoard Member Jan 1, 2015 7.69%
Rachel Ramirez Individual Corporate DirectorBoard Member Jul 1, 2019
Louise R Carmichael Individual Corporate OfficerCeo Dec 1, 2004 100%
W-2 Managing EmployeeCeo Nov 1, 2009 100%
Ashley Horn Individual Corporate OfficerComptroller Nov 1, 2019
Corporate DirectorComptroler Nov 1, 2019
Mary Ann Martin Individual Corporate DirectorSecretary Jul 1, 2019 7.69%
Leslie Warrior Individual Corporate DirectorBoard Member Jul 1, 2019
Jared Deck Individual Corporate DirectorTreasurer Jul 1, 2019 7.69%
Timothy Reddout Individual Corporate OfficerCfo Nov 1, 2019
Corporate DirectorCfo Nov 1, 2019
Donald Nevard Individual Corporate OfficerBoard Member Jul 1, 2019 7.69%
Amy Dunn Individual Corporate OfficerPresident Jul 1, 2019 7.69%

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1255564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582675200000",
    "number": "1982939526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 N GRAND BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731071818",
            "telephone_number": "405-632-6688",
            "fax_number": "405-604-0708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SW 44TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731093540",
            "telephone_number": "405-632-6688",
            "fax_number": "405-235-5208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VARIETY CARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VARIETY CARE, INC",
        "enumeration_date": "2009-10-15",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A",
        "authorized_official_last_name": "REDDOUT",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "405-632-6688"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Variety Care Lafayette",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Variety Care Lafayette",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.