NPIMap

Organization Active NPI

Preferred Hospital Leasing Junction, Inc

Doing business as Rocksprings Medical Clinic

  • Rural Health Clinic/Center
  • Rocksprings, TX
National Provider Identifier
1043815186
Registry record updated Jul 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PREFERRED HOSPITAL LEASING JUNCTION, INC
Doing business as
Rocksprings Medical Clinic
Practice address
212 W. Main Street
Rocksprings, TX 78880
Phone
(325) 446-3305
NPI assigned
Dec 4, 2020
Last updated
Jul 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2022

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

Authorized official

Name
Donald A Freeman
Title
President
Phone
(405) 878-0202

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Rural Health Clinic/Center 261QR1300X Primary
Emergency Medicine Physician 207P00000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

212 W. Main Street
Rocksprings, TX 78880

Mailing address

349 Reid Rd
Junction, TX 76849-3049

Other names 1

  • Rocksprings Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091113000439 TX Part B Supplier - Clinic/Group Practice 4981762051 Receives reassigned benefits from 30 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Junction, TX; Rocksprings, TX
O20201218001063 TX Part A Provider - Rural Health Clinic 4981762051 Practice locations: Rocksprings, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043815186. Details of each certification follow.

Rural health clinic certification: CCN 678559

Legal name
PREFERRED HOSPITAL LEASING JUNCTION, INC
Doing business as
ROCKSPRINGS MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 7, 2021
Last certification
Oct 7, 2021
Ownership / control type
1B
Organization structure
OtherProprietary
Incorporated
Apr 1, 2008 in OK
Enrollment address
212 W. Main Street
Rocksprings, TX 78880-3394
Related CCNs
451306

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Rocksprings Medical Clinic4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

109 Reid Rd
Junction, TX 76849
Phone (325) 446-3305

349 Reid Rd
Junction, TX 76849
Phone (325) 446-3321

399 Reid Rd
Junction, TX 76849
Phone (325) 446-3305

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Donald a Freeman Individual 5% Or Greater Direct Ownership InterestPresident Jan 12, 2021 51%
Preferred Management Corporation Organization, Shawnee, OK Corporation, For-profit Operational/Managerial Control Jan 12, 2021
Duke Young Individual W-2 Managing EmployeeAdministrator Jan 12, 2021
Karla a Betterton Individual Corporate OfficerVice-President of Finance Jan 12, 2021
Josh Tucker Individual Corporate OfficerChief Financial Officer Jan 12, 2021

Facilities with the same owner 35

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

View all 35

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1607040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658188800000",
    "number": "1043815186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "349 REID RD",
            "city": "JUNCTION",
            "state": "TX",
            "postal_code": "768493049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 W. MAIN STREET",
            "city": "ROCKSPRINGS",
            "state": "TX",
            "postal_code": "78880",
            "telephone_number": "325-446-3305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREFERRED HOSPITAL LEASING JUNCTION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-04",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-878-0202"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rocksprings Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rocksprings, TX

Sources for this page

Verify at the official NPI Registry.