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Organization Active NPI

Nacogdoches County Hospital District

Doing business as Nacogdoches Memorial Professional Group

  • Obstetrics & Gynecology Physician
  • Nacogdoches, TX
National Provider Identifier
1053711804
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
NACOGDOCHES COUNTY HOSPITAL DISTRICT
Doing business as
Nacogdoches Memorial Professional Group
Practice address
1204 N Mound St
Nacogdoches, TX 75961
Phone
(936) 568-8523
Fax
(936) 568-8588
NPI assigned
Aug 29, 2014
Last updated
Jun 6, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
NACOGDOCHES COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

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

Authorized official

Name
Johnica Lowery
Title
Director of Operations
Phone
(936) 568-8511

Specialties & licenses 13

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Family Nurse Practitioner 363LF0000X
Women's Health Nurse Practitioner 363LW0102X
Advanced Practice Midwife 367A00000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X
Cardiovascular Disease Physician 207RC0000X
Obstetrics & Gynecology Physician 207V00000X Primary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
Surgery Physician 208600000X
Vascular Surgery Physician 2086S0129X
Urology Physician 208800000X

Addresses

Primary practice location

1204 N Mound St
Nacogdoches, TX 75961

Mailing address

1204 N Mound St
Nacogdoches, TX 75961-4027
Phone (936) 568-8523

Other names 1

  • Nacogdoches Memorial Professional Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040608000604 TX Part B Supplier - Clinic/Group Practice 0446151328 Receives reassigned benefits from 24 practitioners
2 other NPIs on this enrollment
Practice locations: Garrison, TX; Nacogdoches, TX

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
Nacogdoches County Hospital

Locations

1018 N Mound St
Ste 106
Nacogdoches, TX 75961
Phone (936) 569-4682

1204 N Mound St
Ste 201
Nacogdoches, TX 75961

1320 N University Dr
Ste A
Nacogdoches, TX 75961
Phone (936) 560-5200

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Nacogdoches Memorial HospitalNacogdoches, TX, CCN 45S508 Hospital Operational/Managerial Control (100%) Jul 1, 2015
Cecil R. Bomar Rehabilitation CenterNacogdoches, TX, CCN 45T508 Hospital Operational/Managerial Control (100%) Mar 11, 2024
Stonecreek Nursing & RehabilitationSan Augustine, TX, CCN 675729 Skilled nursing facility Operational/Managerial Control (100%) Apr 1, 2017

Owned or controlled facilities with NPI records 3

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

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": "1409270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749168000000",
    "number": "1053711804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 N MOUND ST",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614027",
            "telephone_number": "936-568-8523",
            "fax_number": "936-568-8588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 N MOUND ST",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "75961",
            "telephone_number": "936-568-8523",
            "fax_number": "936-568-8588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NACOGDOCHES COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NACOGDOCHES COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2014-08-29",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A",
        "authorized_official_last_name": "LOWERY",
        "authorized_official_first_name": "JOHNICA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "936-568-8511"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "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
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nacogdoches Memorial Professional Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nacogdoches Memorial Professional Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nacogdoches, TX

Sources for this page

Verify at the official NPI Registry.