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NORTHERN OKLAHOMA REGIONAL PEDIATRIC CLINIC, PLLC
NPI 1053486431
Pediatrics - Adolescent Medicine in Ponca City, OK

Active since November 21, 2006CLIA 37D0475497 · Accreditation
415 FAIRVIEW AVE, STE. 100, PONCA CITY, OK 74601(580) 765-5569(580) 765-2020 Get Directions Write a Review

NPPES record last updated: May 12, 2017. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Northern Oklahoma Regional Pediatric Clinic, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NORTHERN OKLAHOMA REGIONAL PEDIATRIC CLINIC, PLLC (NPI 1053486431) is a healthcare organization registered as an adolescent medicine in Ponca City, Oklahoma and active in the NPI registry since November 2006. The organization holds an CLIA Accreditation certificate valid through December 22, 2027 and lists Chris W Pollak, Administrator, as its authorized official.

NPPES Registry Identity

NPI1053486431
Entity TypeOrganization
Primary Taxonomy2080A0000X
Legal Business NameNORTHERN OKLAHOMA REGIONAL PEDIATRIC CLINIC, PLLC
Location Address415 FAIRVIEW AVE, STE. 100Ponca City, OK 74601-1923
Mailing Address415 Fairview Ave, Ste. 100Ponca City, OK 74601-1923 · (580) 765-5569 · Fax (580) 765-2020
Phone(580) 765-5569
Fax(580) 765-2020
Organization SubpartNo
Authorized OfficialChris W PollakAdministrator · (580) 765-5569
Enumeration DateNovember 21, 2006
Last NPPES UpdateMay 12, 2017
✔ NPI 1053486431 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080A0000X
Definition

A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.

415 FAIRVIEW AVE, Ponca City, OK 74601
Open in Google Maps ↗

Other Identifiers 1

Medicaid100749170COK

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 37D0475497

Northern Oklahoma Regional Pediatric C · Ponca City, OK
Active · expires Dec 22, 2027
CLIA Number37D0475497
Laboratory TypePhysician Office
Certificate Effective DateDecember 23, 2025
Certificate Expiration DateDecember 22, 2027
Laboratory DirectorDr. Michael S. Walker
Laboratory Phone(580) 765-5569
Laboratory LocationNorthern Oklahoma Regional Pediatric C415 Fairview Suite 100, Ponca City, OK 74601
CLIA data matches this NPI record on: Name Phone
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHAREE RESHAWN GOODNO APRN, FNP-C
Nurse Practitioner (Family)
415 FAIRVIEW AVE
PONCA CITY, OK 74601
Kay County (580) 762-9355
DR. DAVID MICHAEL SPARKS M.D.
Orthopaedic Surgery
415 FAIRVIEW AVE, SUITE 201
PONCA CITY, OK 74601
Kay County (580) 762-0202
DR. CANDY LEE SCONYERS LINDSEY D.O.
Family Medicine
415 FAIRVIEW AVE, SUITE 201
PONCA CITY, OK 74601
Kay County (580) 762-9355
LACEY MCNETT CPNP
Nurse Practitioner (Pediatrics)
415 FAIRVIEW AVE, ST 100
PONCA CITY, OK 74601
Kay County (580) 765-5569
DR. DAVID M. SPARKS, M.D., PLLC
Specialist
415 FAIRVIEW AVE, SUITE 201
PONCA CITY, OK 74601
Kay County (580) 762-0202

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Northern Oklahoma Regional Pediatric Clinic, PLLC's NPI number?

The NPI number for Northern Oklahoma Regional Pediatric Clinic, PLLC is 1053486431. It was assigned to this organization in the NPPES registry on November 21, 2006.

Where is Northern Oklahoma Regional Pediatric Clinic, PLLC located?

Northern Oklahoma Regional Pediatric Clinic, PLLC is located at 415 Fairview Ave Ste. 100, Ponca City, OK 74601. The listed phone number is (580) 765-5569.

What is Northern Oklahoma Regional Pediatric Clinic, PLLC's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

Does Northern Oklahoma Regional Pediatric Clinic, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Accreditation (number 37D0475497) is associated with this NPI, valid through December 22, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Northern Oklahoma Regional Pediatric Clinic, PLLC was last updated on May 12, 2017. NPI Profile syncs with the weekly NPPES data releases published by CMS.