NPIMap

Organization Active NPI

Williams Medical Group Practice, LLC

  • Rural Health Clinic/Center
  • Chickasha, OK
National Provider Identifier
1992375737
Registry record updated Feb 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WILLIAMS MEDICAL GROUP PRACTICE, LLC
Practice address
411 W Grand Ave
Chickasha, OK 73018-5862
Phone
(405) 244-0056
NPI assigned
Jun 24, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2023

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

Authorized official

Name
Grant Asay
Title
Ceo
Phone
(405) 445-1210

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

411 W Grand Ave
Chickasha, OK 73018-5862

Mailing address

701 Cedar Lake Blvd Ste 120
Oklahoma City, OK 73114-7815
Phone (405) 445-1210

Other names 1

  • Xpress Wellness Urgent Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210719001557 OK Part A Provider - Rural Health Clinic 3375832157 Practice locations: Chickasha, OK

Rural health clinic certification: CCN 373899

Legal name
WILLIAMS MEDICAL GROUP PRACTICE, LLC
Doing business as
XPRESS WELLNESS URGENT CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 8, 2021
Last certification
Jul 2, 2024
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Dec 9, 2015 in KS
Enrollment address
411 W Grand Ave
Chickasha, OK 73018-5862

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
37D2110863Xpress Wellness Urgent Care411 W Grand Ave, Chickasha, OK 73018Certificate of waiverMar 24, 2028

National Provider Directory

National Provider Directory
Tax ID family
Williams Medical Group Practice LLC36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

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

View all 35

Locations

11462 S Union Ave
Ste F
Jenks, OK 74037
Phone (918) 518-0220

340 S George Nigh Expy
McAlester, OK 74501
Phone (918) 420-9854

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Xpress Wellness LLC Organization, Oklahoma City, OK Management services company Operational/Managerial Control Jul 20, 2018
Joseph M Moore Individual 5% Or Greater Direct Ownership InterestMD Aug 21, 2023 49%
Tony Hill Individual 5% Or Greater Direct Ownership InterestD.O./Cmo Aug 21, 2023 51%
Corporate OfficerChief Medical Officer Nov 1, 2022
W-2 Managing Employee Nov 1, 2022

Owners & managing parties with NPI records 2

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

  • Tony R Hill, DO
    • Emergency Medical Services (Emergency Medicine) Physician
    • Broken Arrow, OK
    • NPI 1295723245

    5% Or Greater Direct Ownership Interest, Corporate Officer, W-2 Managing Employee

    CMS ownership
  • Joseph Michael Moore, MD
    • Internal Medicine Physician
    • Tulsa, OK
    • NPI 1104853142

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 8

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": "1624492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677196800000",
    "number": "1992375737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 CEDAR LAKE BLVD STE 120",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731147815",
            "telephone_number": "405-445-1210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 W GRAND AVE",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730185862",
            "telephone_number": "405-244-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMS MEDICAL GROUP PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-24",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A",
        "authorized_official_last_name": "ASAY",
        "authorized_official_first_name": "GRANT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-445-1210"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Xpress Wellness Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Xpress Wellness Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chickasha, OK

Sources for this page

Verify at the official NPI Registry.