NPIMap

Organization Active NPI

Pecos County Memorial Hospital District

Doing business as Pecos County Memorial Hospital Hospice

  • Community Based Hospice Care Agency
  • Fort Stockton, TX
National Provider Identifier
1043094394
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
PECOS COUNTY MEMORIAL HOSPITAL DISTRICT
Doing business as
Pecos County Memorial Hospital Hospice
Practice address
387 W Ih 10
Fort Stockton, TX 79735
Phone
(432) 336-7044
NPI assigned
Aug 18, 2023
Last updated
Dec 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Betsy L Briscoe
Title
Ceo
Phone
(432) 336-4201

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary
Critical Access Hospital Clinic/Center 261QC0050X

Addresses

Primary practice location

387 W Ih 10
Fort Stockton, TX 79735

Mailing address

387 W Ih 10
Fort Stockton, TX 79735
Phone (432) 336-7044

Other names 1

  • PECOS COUNTY MEMORIAL HOSPITAL HOSPICE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231005000357 TX Part A Provider - Hospice 3173977477 Practice locations: Fort Stockton, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043094394. Details of each certification follow.

Hospice certification: CCN 671732

Legal name
PECOS COUNTY MEMORIAL HOSPITAL DISTRICT
Doing business as
PECOS COUNTY MEMORIAL HOSPITAL HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
May 22, 2012
Last certification
Mar 11, 2021
Ownership / control type
Government - County
Most recent change of ownership
Jun 11, 2024
Organization structure
OtherNon-profit
Enrollment address
387 W Ih 10
Fort Stockton, TX 79735-2708

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Pecos County Memorial Hospital Home Health and HosCCN 671732 · All quality measures
Ownership
Government
Certified
May 22, 2012
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Pecos County Memorial Hospital District6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rebecca Ureta Individual Corporate DirectorChief Financial Officer Jul 1, 2023
W-2 Managing EmployeeChief Financial Officer Jul 1, 2023
Operational/Managerial ControlChief Financial Officer Jul 1, 2023
Pecos County Memorial Hospital District Organization, Fort Stockton, TX 5% Or Greater Direct Ownership Interest Jul 1, 2023
Operational/Managerial Control Jul 1, 2023
Armando Mandujano Individual Corporate DirectorBoard Member Jul 1, 2023
Matt Tarpley Individual Corporate DirectorBoard Member Jul 1, 2023
Lou Ann Tovar Individual Corporate DirectorBoard Member Jul 1, 2023
Betsy Briscoe Individual Corporate DirectorChief Executive Officer Jul 1, 2023
W-2 Managing EmployeeChief Executive Officer Jul 1, 2023
Operational/Managerial ControlChief Executive Officer Jul 1, 2023
Santiago Cantu Individual Corporate DirectorBoard Member Jul 1, 2023
Laura McKenzie Individual Corporate DirectorBoard Member Jul 1, 2023

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pecos County Memorial Hospital DistrictFort Stockton, TX, CCN 451389 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2023
Jul 1, 2023
Pecos County Memorial HospitalFort Stockton, TX, CCN 45Z389 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2023
Jul 1, 2023
Pecos County Memorial Hospital Home Health & HospiceFort Stockton, TX, CCN 673107 Home health agency 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jun 1, 2023
Jun 1, 2023

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Change-of-ownership history 1

DateEventCounterparty
Jul 1, 2023 Change of OwnershipThis provider was the buyer Pecos County Memorial Hospital HospiceCCN 671732, TX, NPI 1780873117

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733270400000",
    "number": "1043094394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "387 W IH 10",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "79735",
            "telephone_number": "432-336-7044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 W IH 10",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "79735",
            "telephone_number": "432-336-7044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECOS COUNTY MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-18",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "BRISCOE",
        "authorized_official_first_name": "BETSY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "432-336-4201"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PECOS COUNTY MEMORIAL HOSPITAL HOSPICE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PECOS COUNTY MEMORIAL HOSPITAL HOSPICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Stockton, TX

Sources for this page

Verify at the official NPI Registry.