Memorial Hermann Health System

Doing business as Memorial Hermann Hospital System

Hospital in Houston, TX, Medicare certification number 450184. CMS publishes 67 quality measures for it.

Medicare certification

Provider of Services

CCN: 450184The number CMS certifies the facility under, not a provider identifier
Status: Active
Provider type: Hospital – Short-term
Listed by Care Compare as: Acute Care Hospitals
Ownership: Voluntary non-profit - Private
Control type: Private (not for profit)
Participating since: Jul 1, 1966
Last certification: Oct 18, 2024
Beds: 1,515
Overall star rating: 3 of 5Care Compare
Address: 1635 North Loop West
Houston, TX 77008
(713) 448-6796

NPI records for this facility (CCN to NPI Mapping) 6

Memorial Hermann Health System

dba MHHS NW Radiation Therapy
- Radiology Clinic/Center
- Houston, TX
- NPI 1013948553
Medicare enrollment
Memorial Hermann Health System

dba MHHS Woodlands Outpatient Imaging System
- Radiology Clinic/Center
- The Woodlands, TX
- NPI 1275564858
Medicare enrollment
Memorial Hermann Health System

dba Memorial Hermann Outpatient Imaging-Southwest
- Radiology Clinic/Center
- Houston, TX
- NPI 1407959448
Medicare enrollment
Memorial Hermann Health System

dba MHHS Friendswood Imaging
- Radiology Clinic/Center
- Friendswood, TX
- NPI 1508896267
Medicare enrollment
Memorial Hermann Health System

dba MHHS Pearland Outpatient Imaging Center
- Radiology Clinic/Center
- Pearland, TX
- NPI 1669402335
Medicare enrollment
Memorial Hermann Health System
- General Acute Care Hospital
- Houston, TX
- NPI 1730132234
Medicare enrollment

Units certified under this facility 1

Provider of Services

Parts of this facility that Medicare certifies under a number of their own, such as a psychiatric or rehabilitation unit.

Memorial Hermann Hospital Inpatient rehabilitation facility, CCN 45T184, 19 measures, 24 providers

Patient survey (HCAHPS) 9

Medicare Care Compare

Cleanliness - star rating Better4 of 5
- State average 3.71 (computed here)
- National average 3.44 (computed here)
- Period from 10/01/2024
Communication about medicines - star rating Worse2 of 5
- State average 2.67 (computed here)
- National average 2.71 (computed here)
- Period from 10/01/2024
Discharge information - star rating Worse2 of 5
- State average 3.07 (computed here)
- National average 3.31 (computed here)
- Period from 10/01/2024
Doctor communication - star rating Worse2 of 5
- State average 2.96 (computed here)
- National average 3.12 (computed here)
- Period from 10/01/2024
Nurse communication - star rating Worse3 of 5
- State average 3.28 (computed here)
- National average 3.43 (computed here)
- Period from 10/01/2024
Overall hospital rating - star rating Worse3 of 5
- State average 3.32 (computed here)
- National average 3.29 (computed here)
- Period from 10/01/2024
Quietness - star rating Worse3 of 5
- State average 3.82 (computed here)
- National average 3.27 (computed here)
- Period from 10/01/2024
Recommend hospital - star rating Better4 of 5
- State average 3.69 (computed here)
- National average 3.64 (computed here)
- Period from 10/01/2024
Summary star rating Worse3 of 5
- State average 3.27 (computed here)
- National average 3.27 (computed here)
- Period from 10/01/2024

Affiliated providers 3,253

Page 1 of 131Medicare Care Compare

Clinicians who list this facility as a hospital or facility affiliation in Care Compare.

Anthonia Ada Abanobi, NP-C
- Family Nurse Practitioner
- Bellaire, TX
- NPI 1720441561
Aamir Abbas, M.D.
- Advanced Heart Failure and Transplant Cardiology Physician
- Houston, TX
- NPI 1487948030
Syed Ali Abbas, MD
- Hospitalist Physician
- Houston, TX
- NPI 1891271904
Elham Abbasi-Hafshejani, M.D.
- Hematology & Oncology Physician
- The Woodlands, TX
- NPI 1306856513
Aisha Abbasi, MD
- Nephrology Physician
- Conroe, TX
- NPI 1942837570
Mohamad Abdalla, MD
- Anesthesiology Physician
- Dallas, TX
- NPI 1073680963
Yazan Abdeen, M.D.
- Pulmonary Disease Physician
- Newark, NJ
- NPI 1679983605
Abdul Ali Abdellatif, M.D.
- Nephrology Physician
- Webster, TX
- NPI 1164560595
Lourice Kamel Abdelmelek, M.D.
- Family Medicine Physician
- Bellaire, TX
- NPI 1316946742
John Abdelsayed, MD
- Surgery Physician
- Sugar Land, TX
- NPI 1578983839
Arif Bin Abdullah, M.D.
- Interventional Cardiology Physician
- Conroe, TX
- NPI 1801803069
Mustafa Abdulrahman, MBCHB
- Hospitalist Physician
- Houston, TX
- NPI 1730615873
Latoya Denise Abernathy, PA-C
- Physician Assistant
- Pearland, TX
- NPI 1083940712
Humaira Abid, M.D.
- Family Medicine Physician
- Houston, TX
- NPI 1326356973
Harry Rafael Sevilla Abilla, NP-C, CRNA, MSN
- Certified Registered Nurse Anesthetist
- Lagrange, GA
- NPI 1053331546
Mai Abouelsaad, M.D.
- Nephrology Physician
- Houston, TX
- NPI 1790168086
Ahmed Abouseif, MBBCH
- Obstetrics & Gynecology Physician
- Houston, TX
- NPI 1831722339
Binu Rajan Abraham, MD
- Anesthesiology Physician
- Dallas, TX
- NPI 1003293788
Glory Abraham, NP
- Family Nurse Practitioner
- Sugar Land, TX
- NPI 1194206490
Megha Abraham, MD
- Sports Medicine (Family Medicine) Physician
- Houston, TX
- NPI 1932738879
Sheila Abrea
- Nurse Practitioner
- Houston, TX
- NPI 1144781774
Rodeo Apurado Abrencillo, M.D.
- Critical Care Medicine (Internal Medicine) Physician
- Houston, TX
- NPI 1164716635
Juan Ariel Abreu, M.D.
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Houston, TX
- NPI 1598053092
Raja Abusharr, M.D.
- Family Medicine Physician
- The Woodlands, TX
- NPI 1215993084
Gyanendra Kumar Acharya, MD
- Hospitalist Physician
- Houston, TX
- NPI 1689099756

Complications and deaths 20

Medicare Care Compare

Abdominopelvic accidental puncture or laceration rate As expected0.99
- State average 1.03 (computed here)
- National average 1.06
- No different than the national rate
- 4,154 patients
- Period from 07/01/2022
CMS Medicare PSI 90: Patient safety and adverse events composite As expected1.02
- State average 0.97 (computed here)
- National average 1
- No different than the national value
- Period from 07/01/2022
Death rate among surgical inpatients with serious treatable complications Better137.67
- State average 166 (computed here)
- National average 173.3
- Better than the national rate
- 432 patients
- Period from 07/01/2022
Death rate for CABG surgery patients As expected1.7
- State average 2.71 (computed here)
- National average 2.4
- No different than the national rate
- 221 patients
- Period from 07/01/2022
Death rate for COPD patients As expected9.4
- State average 8.7 (computed here)
- National average 8.6
- No different than the national rate
- 319 patients
- Period from 07/01/2022
Death rate for heart attack patients As expected12.4
- State average 11.91 (computed here)
- National average 11.9
- No different than the national rate
- 392 patients
- Period from 07/01/2022
Death rate for heart failure patients As expected9.9
- State average 10.52 (computed here)
- National average 11.1
- No different than the national rate
- 1,296 patients
- Period from 07/01/2022
Death rate for pneumonia patients As expected14.2
- State average 14.69 (computed here)
- National average 15.2
- No different than the national rate
- 1,475 patients
- Period from 07/01/2022
Death rate for stroke patients As expected11.5
- State average 12.01 (computed here)
- National average 11.9
- No different than the national rate
- 1,350 patients
- Period from 07/01/2023
Hybrid Hospital-Wide All-Cause Risk Standardized Mortality Rate Better3
- State average 3.89 (computed here)
- National average 3.9
- Better than the national rate
- 14,781 patients
- Period from 07/01/2024
Iatrogenic pneumothorax rate As expected0.2
- State average 0.21 (computed here)
- National average 0.21
- No different than the national rate
- 19,726 patients
- Period from 07/01/2022
In-hospital fall-associated fracture rate As expected0.19
- State average 0.26 (computed here)
- National average 0.27
- No different than the national rate
- 20,235 patients
- Period from 07/01/2022
Perioperative pulmonary embolism or deep vein thrombosis rate As expected4.34
- State average 3.34 (computed here)
- National average 3.52
- No different than the national rate
- 5,295 patients
- Period from 07/01/2022
Postoperative acute kidney injury requiring dialysis rate As expected1.1
- State average 1.62 (computed here)
- National average 1.67
- No different than the national rate
- 1,329 patients
- Period from 07/01/2022
Postoperative hemorrhage or hematoma rate Better1.26
- State average 2.31 (computed here)
- National average 2.34
- Better than the national rate
- 4,969 patients
- Period from 07/01/2022
Postoperative respiratory failure rate As expected9.88
- State average 10.06 (computed here)
- National average 9.42
- No different than the national rate
- 1,369 patients
- Period from 07/01/2022
Postoperative sepsis rate Worse9.19
- State average 5.23 (computed here)
- National average 5.27
- Worse than the national rate
- 1,305 patients
- Period from 07/01/2022
Postoperative wound dehiscence rate As expected2.08
- State average 1.77 (computed here)
- National average 1.77
- No different than the national rate
- 1,174 patients
- Period from 07/01/2022
Pressure ulcer rate Better0.26
- State average 0.52 (computed here)
- National average 0.63
- Better than the national rate
- 17,391 patients
- Period from 07/01/2022
Rate of complications for hip/knee replacement patients As expected4.6
- State average 4.14 (computed here)
- National average 4.1
- No different than the national rate
- 58 patients
- Period from 04/01/2023

Infections 6

Medicare Care Compare

Catheter Associated Urinary Tract Infections (ICU + select Wards) Better0.2
- State average 0.35
- National average 1
- Better than the national benchmark
- Period from 10/01/2024
Central Line Associated Bloodstream Infection (ICU + select Wards) Better0.51
- State average 0.48
- National average 1
- Better than the national benchmark
- Period from 10/01/2024
Clostridium Difficile (C.Diff) Better0.17
- State average 0.24
- National average 1
- Better than the national benchmark
- Period from 10/01/2024
MRSA Bacteremia Better0.45
- State average 0.6
- National average 1
- Better than the national benchmark
- Period from 10/01/2024
SSI - Abdominal Hysterectomy As expected1.81
- State average 0.92
- National average 1
- No different than national benchmark
- Period from 10/01/2024
SSI - Colon Surgery As expected0.6
- State average 0.73
- National average 1
- No different than national benchmark
- Period from 10/01/2024

Outpatient imaging 2

Medicare Care Compare

Abdomen CT Use of Contrast Material 10.2
- State average 7.72 (computed here)
- National average 5.83 (computed here)
- Period from 07/01/2024
Breast Cancer Screening Recall Rates 5.8
- State average 6.86 (computed here)
- National average 8.08 (computed here)
- Period from 07/01/2024

Spending per patient 1

Medicare Care Compare

Medicare hospital spending per patient (Medicare Spending per Beneficiary) 1
- State average 1.03
- National average 0.99 (computed here)
- Period from 01/01/2024

Timely and effective care 18

Medicare Care Compare

Appropriate care for severe sepsis and septic shock 43
- State average 68
- National average 65
- 699 patients
- Period from 10/01/2024
Average (median) time all patients spent in the emergency department before leaving from the visit, including psychiatric/mental health patients and patients who were transferred to another facility. A lower number of minutes is better 247
- State average 150
- National average 168
- 428 patients
- Period from 10/01/2024
Average (median) time patients spent in the emergency department before being transferred to another facility. A lower number of minutes is better 329
- State average 260
- National average 287
- 12 patients
- Period from 10/01/2024
Average (median) time patients spent in the emergency department before leaving from the visit, excluding patients transferred to another facility or psychiatric care/mental health patients. A lower number of minutes is better 243
- State average 145
- National average 162
- 401 patients
- Period from 10/01/2024
Average (median) time psychiatric/mental health patients spent in the emergency department before leaving from the visit. A lower number of minutes is better 438
- State average 233
- National average 257
- 15 patients
- Period from 10/01/2024
Discharged on Antithrombotic Therapy 93
- State average 93.64 (computed here)
- National average 96.1 (computed here)
- 1,288 patients
- Period from 01/01/2024
Endoscopy/polyp surveillance: appropriate follow-up interval for normal colonoscopy in average risk patients 93
- State average 92
- National average 93
- 271 patients
- Period from 01/01/2024
Head CT results 45
- State average 67
- National average 69
- 88 patients
- Period from 10/01/2024
Healthcare workers given influenza vaccination 95
- State average 74
- National average 78
- 17,082 patients
- Period from 10/01/2024
Hospital Harm - Severe Hyperglycemia 8
- State average 6.38 (computed here)
- National average 8.08 (computed here)
- 139,254 patients
- Period from 01/01/2024
Left before being seen 1
- State average 1
- National average 2
- 296,823 patients
- Period from 01/01/2024
Safe Use of Opioids - Concurrent Prescribing 10
- State average 14
- National average 15
- 10,826 patients
- Period from 01/01/2024
Septic Shock 3-Hour Bundle 64
- State average 74
- National average 73
- 160 patients
- Period from 10/01/2024
Septic Shock 6-Hour Bundle 74
- State average 89
- National average 87
- 62 patients
- Period from 10/01/2024
Severe Sepsis 3-Hour Bundle 62
- State average 83
- National average 81
- 699 patients
- Period from 10/01/2024
Severe Sepsis 6-Hour Bundle 81
- State average 93
- National average 93
- 292 patients
- Period from 10/01/2024
ST-Segment Elevation Myocardial Infarction (STEMI) 79
- State average 41.08 (computed here)
- National average 46.51 (computed here)
- 42 patients
- Period from 01/01/2024
Venous Thromboembolism Prophylaxis 90
- State average 78.56 (computed here)
- National average 82.23 (computed here)
- 39,533 patients
- Period from 01/01/2024

Measures CMS does not publish for this facility (12)

Anticoagulation Therapy for Atrial Fibrillation/Flutter — 5
Antithrombotic Therapy by End of Hospital Day 2 — 5
Emergency department volume — very high
Global Malnutrition Composite Score — 5
Global Malnutrition Composite Score: Malnutrition Diagnosis Documented — 5
Global Malnutrition Composite Score: Malnutrition Risk Screening — 5
Global Malnutrition Composite Score: Nutrition Assessment — 5
Global Malnutrition Composite Score: Nutritional Care Plan — 5
Hospital Harm - Opioid Related Adverse Events — 5
Hospital Harm - Severe Hypoglycemia — 5
Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery — 5
Intensive Care Unit Venous Thromboembolism Prophylaxis — 5

Unplanned visits 11

Medicare Care Compare

Acute Myocardial Infarction (AMI) 30-Day Readmission Rate As expected15.5
- State average 14.48 (computed here)
- National average 14.4
- No different than the national rate
- 917 patients
- Period from 07/01/2023
Heart failure (HF) 30-Day Readmission Rate As expected21.4
- State average 21.26 (computed here)
- National average 21.3
- No different than the national rate
- 3,791 patients
- Period from 07/01/2023
Hospital return days for heart attack patients 39.2
- State average 11.3 (computed here)
- National average 6.71 (computed here)
- Average days per 100 discharges
- 394 patients
- Period from 07/01/2022
Hospital return days for heart failure patients 10.6
- State average -1.32 (computed here)
- National average 4.02 (computed here)
- Average days per 100 discharges
- 1,546 patients
- Period from 07/01/2022
Hospital return days for pneumonia patients 15.5
- State average 2.42 (computed here)
- National average 5.65 (computed here)
- Average days per 100 discharges
- 1,521 patients
- Period from 07/01/2022
Pneumonia (PN) 30-Day Readmission Rate As expected18
- State average 17.32 (computed here)
- National average 17.3
- No different than the national rate
- 3,278 patients
- Period from 07/01/2023
Rate of readmission after hip/knee replacement As expected5.5
- State average 5.89 (computed here)
- National average 5.8
- No different than the national rate
- 51 patients
- Period from 07/01/2023
Rate of readmission for CABG As expected11.5
- State average 11.35 (computed here)
- National average 11
- No different than the national rate
- 423 patients
- Period from 07/01/2023
Rate of readmission for chronic obstructive pulmonary disease (COPD) patients As expected20.7
- State average 19.85 (computed here)
- National average 20
- No different than the national rate
- 960 patients
- Period from 07/01/2023
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies) As expected12.7
- State average 13.1 (computed here)
- National average 13
- No different than the national rate
- 2,275 patients
- Period from 01/01/2022
Ratio of unplanned hospital visits after hospital outpatient surgery As expected1
- State average 1.02 (computed here)
- National average 1.01 (computed here)
- No different than expected
- 1,658 patients
- Period from 01/01/2024

Measures CMS does not publish for this facility (3)

Hybrid Hospital-Wide All-Cause Readmission Measure (HWR) — 4
Rate of emergency department (ED) visits for patients receiving outpatient chemotherapy — 1
Rate of inpatient admissions for patients receiving outpatient chemotherapy — 1

Other hospitals in Houston, TX

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Memorial City Emergency Center LLC terminated
Memorial Hermann - Texas Medical Center
Memorial Hermann Continuing Care SW 7600 Beechnut 7TH Floor terminated
Memorial Hermann Continuing Care SW 7600 Beechnut 7TH Floor terminated
Memorial Hermann Memorial City Hospital
Meridian Hospital PLLC
Pine Valley Specialty Hospital terminated
Post Oak ER, LLC terminated
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Sources for this page

Provider of Services: the certification, provider type, beds and status.
Medicare Care Compare: the star rating and every measure on this page, with the state and national rates CMS publishes beside them, and the clinicians who list this facility as an affiliation.
NPPES NPI Registry: the NPI records connected to this certification and the names of the providers listed above.

Better and worse are CMS's own comparison with the national rate, not ours: for most measures a low score is the good one (deaths, infections) and for others a high one is, so measures where CMS states no comparison are left uncoloured. The exception is star ratings, which are read against the national average here. Quality measures are published by CMS and are not adjusted or re-scored here. Averages marked “computed here” are the mean of every facility reporting that measure, worked out by NPIMap because CMS publishes no comparison for it. Confirm anything you rely on at Medicare Care Compare.