UTICA PARK CLINIC PRIMARY CARE
NPI 1295232478
Clinic/Center - Rural Health in Henryetta, OK
About Utica Park Clinic Primary Care NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
UTICA PARK CLINIC PRIMARY CARE (NPI 1295232478) is a healthcare organization registered as a rural health in Henryetta, Oklahoma and active in the NPI registry since April 2018. The organization holds a CLIA Waiver certificate valid through January 24, 2027 and lists Stephen C. Petrovich, Evp, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Utica Park Clinic Primary Care is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by March 31, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
12Medicare enrollment records show 12 clinicians reassign Medicare billing to Utica Park Clinic Primary Care, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 5 within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 6
Clinicians, nearest first (12)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Waiver 37D2053123
Utica Park Clinic Primary Care · Henryetta, OKFrequently 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 Ahs Henryetta Hospital LLC's NPI number?
The NPI number for Ahs Henryetta Hospital LLC is 1295232478. It was assigned to this organization in the NPPES registry on April 12, 2018. The provider is doing business as Utica Park Clinic Primary Care.
Where is Ahs Henryetta Hospital LLC located?
Ahs Henryetta Hospital LLC is located at 2405 W Main St Ste A, Henryetta, OK 74437. The listed phone number is (918) 650-1180.
What is Ahs Henryetta Hospital LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.
Is Ahs Henryetta Hospital LLC enrolled in Medicare?
Yes. Ahs Henryetta Hospital LLC is registered in the Medicare PECOS enrollment system.
When is Ahs Henryetta Hospital LLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Oklahoma, Clinic/Group Practice) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Ahs Henryetta Hospital LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 12 clinicians in 6 Medicare specialties reassign their Medicare billing to Ahs Henryetta Hospital LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (4), Family Practice (2) and General Surgery (2). Of these, 2 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Ahs Henryetta Hospital LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 37D2053123) is associated with this NPI, valid through January 24, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Ahs Henryetta Hospital LLC accept?
Health plans from Blue Cross and Blue Shield of Oklahoma, Oscar Insurance Company and UnitedHealthcare list Ahs Henryetta Hospital LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Ahs Henryetta Hospital LLC was last updated on May 29, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Utica Park Clinic Primary Care · NPI 1295232478
Rural Health organization in Henryetta, Oklahoma. Organization record, active in the CMS NPPES registry since April 12, 2018.
## Identity
- **NPI:** 1295232478 (Entity type: Organization)
- **Enumerated:** April 12, 2018
- **Primary specialty:** Clinic/Center - Rural Health · taxonomy 261QR1300X
- **Legal business name:** Ahs Henryetta Hospital Llc
- **Organization subpart:** Yes (part of Ahs Hillcrest Healthcare System, Llc)
- **Authorized official:** Stephen Petrovich, EVP
## Practice location
- **Address:** 2405 W MAIN ST STE A, Henryetta, OK 74437
- **Phone:** (918) 650-1180 · **Fax:** (918) 650-1294
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** March 31, 2027 (Non-DME Part B, Oklahoma, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 12 clinicians in 6 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (4), Family Practice (2), General Surgery (2); 2 practice at this address and 5 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 29, 2019
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1295232478) · Data from the CMS NPPES public registry.