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SSM HEALTH MEDICAL GROUP SHAWNEE KICKAPOO CLINIC
NPI 1093395618
Clinic/Center - Rural Health in Shawnee, OK

Active since April 08, 2021CLIA Certified · 3 labs
3700 N KICKAPOO AVE, SHAWNEE, OK 74804(405) 273-6383(405) 273-3748 Get Directions Write a Review

NPPES record last updated: March 27, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 16, 2021, Apr 8, 2021 (2 updates tracked since 2021).

About Ssm Health Medical Group Shawnee Kickapoo Clinic NPPES

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

SSM HEALTH MEDICAL GROUP SHAWNEE KICKAPOO CLINIC (NPI 1093395618) is a healthcare organization registered as a rural health in Shawnee, Oklahoma and active in the NPI registry since April 2021. The organization holds 3 active CLIA laboratory certificates and lists Shasta Rene Manuel, Vice President - Finance, as its authorized official.

NPPES Registry Identity

NPI1093395618
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameSAINTS MEDICAL GROUP, LLC
Location Address3700 N KICKAPOO AVEShawnee, OK 74804-1707
Mailing Address3700 N Kickapoo AveShawnee, OK 74804-1707 · (405) 273-6383 · Fax (405) 273-3748
Phone(405) 273-6383
Fax(405) 273-3748
Organization SubpartNo
Authorized OfficialShasta Rene ManuelVice President - Finance · (405) 272-7282
Enumeration DateApril 8, 2021
Last NPPES UpdateMarch 27, 20242 updates tracked since enumeration
NPPES CertifiedMarch 27, 2024
✔ NPI 1093395618 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedOtolaryngologyTaxonomy 207Y00000X
Also ListedAudiologistTaxonomy 231H00000X
Also ListedPhysician Assistant · MedicalTaxonomy 363AM0700X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
3700 N KICKAPOO AVE, Shawnee, OK 74804
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Other Names 1

Doing Business AsSsm Health Medical Group Shawnee Kickapoo Clinic

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

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 Waiver 37D1102412

Ssm Health Medical Group · Shawnee, OK
Active · expires Jan 13, 2028
CLIA Number37D1102412
Laboratory TypePhysician Office
Certificate Effective DateJanuary 14, 2026
Certificate Expiration DateJanuary 13, 2028
Laboratory DirectorLevi Jones
Laboratory Phone(405) 273-5801
Laboratory LocationSsm Health Medical Group3214 Kethley Road, Shawnee, OK 74804
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Accreditation 37D0697941

Ssm Health Medical Group · Shawnee, OK
Active · expires Aug 11, 2027
CLIA Number37D0697941
Laboratory TypePhysician Office
Certificate Effective DateAugust 12, 2025
Certificate Expiration DateAugust 11, 2027
Laboratory DirectorLevi Jones
Laboratory Phone(405) 273-5801
Laboratory LocationSsm Health Medical Group3315 Kethley Road, Shawnee, OK 74804
CLIA data matches this NPI record on: Name
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.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 37D2221543

Ssm Health Medical Group · Shawnee, OK
Active · expires Apr 21, 2027
CLIA Number37D2221543
Laboratory TypePhysician Office
Certificate Effective DateApril 22, 2025
Certificate Expiration DateApril 21, 2027
Laboratory DirectorS N Levi Jones
Laboratory Phone(405) 878-7160
Laboratory LocationSsm Health Medical Group4651 N Harrison, Shawnee, OK 74804
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 12

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

MIDWEST CITY HMA PHYSICIAN MANAGEMENT, LLC
Internal Medicine (Cardiovascular Disease)
3700 N KICKAPOO AVE, SUITE 104
SHAWNEE, OK 74804
Pottawatomie County (405) 273-6383
VALIR HEALTH LLC
Clinic/Center (Medical Specialty)
3700 N KICKAPOO AVE
SHAWNEE, OK 74804
Pottawatomie County (405) 214-9808
BONNIE NADAENE GRUDE
Nurse Practitioner (Family)
3700 N KICKAPOO AVE
SHAWNEE, OK 74804
Pottawatomie County (405) 273-6383
BRANDI STRAYHORN
Physician Assistant (Medical)
3700 N KICKAPOO AVE
SHAWNEE, OK 74804
Pottawatomie County (405) 273-6383
SHAWNEE MRI ASSOCIATES, L.L.C.
Clinic/Center (Magnetic Resonance Imaging (MRI))
3700 N KICKAPOO AVE, SUITE 116
SHAWNEE, OK 74804
Pottawatomie County (405) 275-6747
FAMILY MEDICINE SPECIALISTS, P.C.
Family Medicine
3700 N KICKAPOO AVE, SUITE 124
SHAWNEE, OK 74804
Pottawatomie County (405) 273-6383
MIDWEST CITY HMA PHYSICIAN MANAGEMENT LLC
Internal Medicine
3700 N KICKAPOO AVE, SUITE 104
SHAWNEE, OK 74804
Pottawatomie County (405) 273-6383
HEARTLAND HOSPICE-SHAWNEE
Hospice Care, Community Based
3700 N KICKAPOO AVE, SUITE 104
SHAWNEE, OK 74804
Pottawatomie County (405) 214-6442

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 Saints Medical Group, LLC's NPI number?

The NPI number for Saints Medical Group, LLC is 1093395618. It was assigned to this organization in the NPPES registry on April 8, 2021. The provider is doing business as Ssm Health Medical Group Shawnee Kickapoo Clinic.

Where is Saints Medical Group, LLC located?

Saints Medical Group, LLC is located at 3700 N Kickapoo Ave, Shawnee, OK 74804. The listed phone number is (405) 273-6383.

What is Saints Medical Group, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

Does Saints Medical Group, LLC hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Saints Medical Group, LLC was last updated on March 27, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.