NORTHEASTERN HEALTH SYSTEM (NPI# 1528122371) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528122371 |
| Entity Type | Organization |
| Organization Name | NORTHEASTERN HEALTH SYSTEM |
| Other Organization Name | TAHLEQUAH HOSPITAL AUTHORITY |
| Practice Address |
1400 E Downing St Tahlequah OK 74464-3324 |
| Mailing Address |
1400 E Downing St Po Box 1008 Tahlequah OK 74464-3324 |
| Practice Telephone | 9184560641 |
| Mailing Telephone | 9184560641 |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2014-08-06 |
| Authorized Official Name | MR. BRIAN WOODLIFF (CEO) |
| Authorized Official Telephone | 9184560641 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 273Y00000X | Rehabilitation Unit | 2178 | OK | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100700680A | 05 |
| Other Name | Type Code |
|---|---|
| TAHLEQUAH HOSPITAL AUTHORITY | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366983850 | Northeastern Health System | Clinic/Center | 1203 E Ross Byp Ste A, Tahlequah, OK 74464-4158 | 2017-03-16 |
| 1013458652 | Northeastern Health System | Clinic/Center | 104 Lone Oak Cir, Fort Gibson, OK 74434-5001 | 2017-03-15 |
| 1306387949 | Northeastern Health System | Clinic/Center | 1201 E Ross Byp, Tahlequah, OK 74464-4188 | 2017-03-15 |
| 1871717819 | Northeastern Health System | Ambulance | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2007-04-12 |
| 1457574170 | Northeastern Health System | Emergency Medicine | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2007-04-11 |
| 1619031465 | Northeastern Health System | Psychiatric Unit | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2006-12-19 |
| 1003865999 | Northeastern Health System | Emergency Medicine | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2006-05-08 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | NORTHEASTERN HEALTH SYSTEM | 1400 E Downing St, Tahlequah, OK 74464-3324 |
| Street Address |
1400 E DOWNING ST |
| City | TAHLEQUAH |
| State | OK |
| Zip Code | 74464-3324 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770581001 | Teresa Lynn Toombs | Nurse Anesthetist, Certified Registered | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2005-07-11 |
| 1508481292 | Christopher B Gaskins | Internal Medicine | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2020-06-09 |
| 1790309938 | Bryan John Butel | Student in an Organized Health Care Education/Training Program | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2020-06-03 |
| 1205463767 | Rahim Ruknudin Sewani | Student in an Organized Health Care Education/Training Program | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2020-03-25 |
| 1679104780 | Ashley Cheyenne Sevilla | Physical Therapy Assistant | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2020-01-28 |
| 1972144475 | Shelly Diane Prince | Nurse Practitioner | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2019-10-05 |
| 1700447752 | Thucnhi Nguyen | Physical Therapist | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2019-06-20 |
| 1447814256 | Laura Beth Harlen | Occupational Therapist | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2019-04-26 |
| 1215590260 | Lyndsey Daggs | Student in an Organized Health Care Education/Training Program | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2019-04-16 |
| 1174186183 | James L Wood | Student in an Organized Health Care Education/Training Program | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2019-04-16 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184253403 | Kendall Harris | Student in an Organized Health Care Education/Training Program | 100 Bliss Ave, Tahlequah, OK 74464 | 2020-04-07 |
| 1528609302 | Norma Brightly | Technician | 103 Sequoyah, Tahlequah, OK 74464 | 2019-10-03 |
| 1073175832 | Jody Lynn Dallis | Case Manager/Care Coordinator | Tenkiller Behavioral Services, 27753 S. Welling Rd, Welling, OK 74464 | 2019-07-02 |
| 1184287849 | Perry Jake Proctor | Student in an Organized Health Care Education/Training Program | 1400 E Downing St, Tahlequah, Ok 74464, Tahlequah, OK 74464 | 2019-04-18 |
| 1336657279 | Sidney Sheyenne Kimble | Case Manager/Care Coordinator | 1429 Jack Brown Lane, Tahlequah, OK 74464 | 2018-01-12 |
| 1891225686 | Nichols Bradley Alberty | Orthotist | 1294 East Downing, Suite 3, Tahlequah, OK 74464 | 2017-06-14 |
| 1922549690 | Krystal Easter Ms, Lpc | Counselor | 2201 Oakridge Dr, Tahlequah, OK 74464 | 2017-03-15 |
| 1144777319 | Northeastern Oklahoma Community Health Centers, Inc. | Clinic/Center | 529 N. Oak St., Tahlequah, OK 74464 | 2016-09-06 |
| 1548713456 | Clement Isioma Nwadozi | Optometrist | 3763 Southridge Cir Apt 6, Tahlequah, OK 74464 | 2016-07-27 |
| 1033532635 | Wesley Gragg | Specialist/Technologist | 603 North Grand Avenue, Tahlequah, OK 74464 | 2014-02-03 |
| Find all providers in zip 74464 | ||||
| Taxonomy Code | 273Y00000X |
| Grouping | Hospital Units |
| Classification | Rehabilitation Unit |
| In general, a distinct unit of a general acute care hospital that provides care encompassing a comprehensive array of restoration services for the disabled and all support services necessary to help patients attain their maximum functional capacity. Source: AHA Annual Survey p. A10 1996 AHA Guide. For Medicare, a distinct part of a general acute care hospital providing inpatient rehabilitation services that meets the following requirements. Rehabilitation Units have in effect a preadmission screening procedure under which each prospective patient’s condition and medical history are reviewed to determine whether the patient is likely to benefit significantly from an intensive inpatient program or assessment; ensure that the patients receive close medical supervision and furnish, through the use of qualified personnel, rehabilitation nursing, physical therapy and occupational therapy, plus, as needed, speech therapy, social services or psychological services and orthotic and prosthetic services; have a plan of treatment for each inpatient that is established, reviewed, and revised as needed by a physician in consultation with other professional personnel who provide services to the patient; use a coordinated multidisciplinary team approach in the rehabilitation of each inpatient, as documented by periodic clinical entries made in the patient’s medical record to note the patient's status in relationship to goal attainment, and that team conferences are held at least every two weeks to determine the appropriateness of treatment; have a director of rehabilitation who provides services to the unit and its inpatients for at least 20 hours a week, is a doctor of medicine or osteopathy, is licensed under State law to practice medicine or surgery, and has had, after completing a one-year hospital internship at least two years of training or experience in the medical management of inpatients requiring rehabilitation services. |
| Notes: Source: Code of Federal Regulations #42, Section 412.29. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740716018 | Jai Shree Hanuman, LLC | Rehabilitation Unit | 6101 N Santa Fe Ave, Oklahoma City, OK 73118-7526 | 2017-05-05 |
| 1659398618 | Comanche County Healthcare Corporation Dba Center for Occupational Hea | Rehabilitation Unit | 602 Se Wallock St, Lawton, OK 73501-5444 | 2006-07-16 |
| 1023064300 | Brookhaven Hospital Inc. | Rehabilitation Unit | 201 S Garnett Rd, Tulsa, OK 74128 | 2006-05-26 |
| 1033113097 | St. Anthony Shawnee Hospital, Inc | Rehabilitation Unit | 1900 S Gordon Cooper Dr, Shawnee, OK 74801 | 2005-06-08 |
| 1831663657 | Integris Baptist Medical Center, Inc | Rehabilitation Unit | 5501 N Portland Ave, Oklahoma City, OK 73112-2074 | 2019-01-15 |
| 1306381561 | Saint Francis Hospital Muskogee Inc | Rehabilitation Unit | 300 Rockefeller Dr, Muskogee, OK 74401-5075 | 2016-12-27 |
| 1932442019 | Mercy Hospital Ada, Inc | Rehabilitation Unit | 430 N Monte Vista St, Ada, OK 74820-4610 | 2013-03-27 |
| 1811193964 | Linda Sue Church | Rehabilitation Unit | 3401 W Gore Blvd, Lawton, OK 73505-6332 | 2007-06-25 |
| 1003039488 | Saint Francis Hospital, Inc. | Rehabilitation Unit | 6161 S Yale Ave, Tulsa, OK 74136-1902 | 2007-04-11 |
| 1053456111 | Jane Phillips Memorial Medical Center, Inc | Rehabilitation Unit | 3500 E Frank Phillips Blvd, Bartlesville, OK 74006-2411 | 2007-02-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.