UTICA PARK CLINIC FAMILY MEDICINE
NPI 1740787928
Clinic/Center - Rural Health in Pryor, OK
About Utica Park Clinic Family Medicine NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
UTICA PARK CLINIC FAMILY MEDICINE (NPI 1740787928) is a healthcare organization registered as a rural health in Pryor, Oklahoma and active in the NPI registry since April 2018. The organization holds a CLIA Waiver certificate valid through April 30, 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 and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Utica Park Clinic Family Medicine is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
12Medicare enrollment records show 12 clinicians reassign Medicare billing to Utica Park Clinic Family Medicine, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 9 within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 3
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 37D1088768
Utica Park Clinic Family Medicine Ahs Pryor Hospital, LLC · Pryor, 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 Pryor Hospital, LLC's NPI number?
The NPI number for Ahs Pryor Hospital, LLC is 1740787928. It was assigned to this organization in the NPPES registry on April 12, 2018. The provider is doing business as Utica Park Clinic Family Medicine.
Where is Ahs Pryor Hospital, LLC located?
Ahs Pryor Hospital, LLC is located at 1301 NE 1st St Ste 400, Pryor, OK 74361. The listed phone number is (918) 824-8000.
What is Ahs Pryor Hospital, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.
Is Ahs Pryor Hospital, LLC enrolled in Medicare?
Yes. Ahs Pryor Hospital, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Ahs Pryor Hospital, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 12 clinicians in 3 Medicare specialties reassign their Medicare billing to Ahs Pryor 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 Family Practice (8), Internal Medicine (2) and Nurse Practitioner (2). Of these, 3 practice at this address and 9 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Ahs Pryor Hospital, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 37D1088768) is associated with this NPI, valid through April 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Ahs Pryor Hospital, LLC accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 1 other insurer list Ahs Pryor 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 Pryor Hospital, LLC was last updated on June 4, 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 Family Medicine · NPI 1740787928
Rural Health organization in Pryor, Oklahoma. Organization record, active in the CMS NPPES registry since April 12, 2018.
## Identity
- **NPI:** 1740787928 (Entity type: Organization)
- **Enumerated:** April 12, 2018
- **Primary specialty:** Clinic/Center - Rural Health · taxonomy 261QR1300X
- **Legal business name:** Ahs Pryor Hospital, Llc
- **Organization subpart:** No
- **Authorized official:** Stephen Petrovich, EVP
## Practice location
- **Address:** 1301 NE 1ST ST STE 400, Pryor, OK 74361
- **Phone:** (918) 824-8000 · **Fax:** (918) 825-5505
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 12 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (8), Internal Medicine (2), Nurse Practitioner (2); 3 practice at this address and 9 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 4, 2019
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1740787928) · Data from the CMS NPPES public registry.