NPIMap

Organization Active NPI

The West Texas Rehabilitation Center

Doing business as Hospice of San Angelo

  • Community Based Hospice Care Agency
  • San Angelo, TX
National Provider Identifier
1063911618
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
THE WEST TEXAS REHABILITATION CENTER
Doing business as
Hospice of San Angelo
Practice address
1933 University Ave
San Angelo, TX 76904
Phone
(325) 793-3400
Fax
(325) 793-3587
NPI assigned
Feb 9, 2018
Last updated
Jun 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
THE WEST TEXAS REHABILITATION CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Authorized official

Name
Matthew Butler
Title
Cfo
Phone
(325) 793-3529

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary
Inpatient Hospice 315D00000X

Addresses

Primary practice location

1933 University Ave
San Angelo, TX 76904

Mailing address

4601 Hartford St
Abilene, TX 79605-4603
Phone (325) 793-3400

Other names 1

  • Hospice of San Angelo Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180410002812 TX Part A Provider - Hospice 2860301215 1 other NPI on this enrollment
Practice locations: San Angelo, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063911618. Details of each certification follow.

Hospice certification: CCN 451532

Legal name
THE WEST TEXAS REHABILITATION CENTER
Doing business as
HOSPICE OF SAN ANGELO
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 10, 1989
Last certification
Mar 24, 2021
Ownership / control type
Non-Profit - Other
Organization structure
CorporationNon-profit
Enrollment address
1933 University Ave
San Angelo, TX 76904-5133

Other NPIs with the same Medicare PAC ID 4

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.

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice of San AngeloCCN 451532 · All quality measures
Ownership
Non-Profit
Certified
Mar 10, 1989
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
The West Texas Rehabilitation Center8 organizations share this tax ID, including this one
Part of
The West Texas Rehabilitation Center

Other organizations with this tax ID 7

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

Locations

1933 University Ave
San Angelo, TX 76904
Phone (325) 793-3400

3501 Knickerbocker Rd
Fl 3
San Angelo, TX 76904
Phone (325) 222-8399

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Amy Nichols Individual W-2 Managing EmployeeAd; Sep 1, 2020
The West Texas Rehabilitation Center Organization, Abilene, TX Corporation, Non-profit Other Mar 1, 2018
Faye Smith Individual Corporate OfficerChair Board of Directors Jan 1, 2018
Corporate DirectorChair, Board of Directors Jan 1, 2018
Kerry Rene Bender Individual Corporate DirectorDirector of Patient Accounting Aug 26, 2024
Matthew Butler Individual Corporate Officer Aug 14, 2023
W-2 Managing Employee Aug 14, 2023
Operational/Managerial ControlAuthorized Official Aug 14, 2023
Tiffany Wagstaff Individual Corporate OfficerSecretary/Board of Directors Jan 1, 2018
Corporate DirectorSecretary/Board of Directors Jan 1, 2018
Scott Jameson Individual Corporate OfficerCoo Sep 1, 2015
Operational/Managerial ControlCoo Sep 1, 2015
Steve W Martin Individual W-2 Managing EmployeeCeo Mar 1, 2018
Operational/Managerial ControlCeo Sep 1, 2015
Kirk S Brewer Individual Contracted Managing EmployeeMD; May 16, 2022
Corporate DirectorMedical Director May 16, 2022

Owners & managing parties with NPI records 5

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

Owned or controlled facilities with NPI records 1

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

Change-of-ownership history 1

DateEventCounterparty
Mar 1, 2018 Change of OwnershipThis provider was the buyer Hospice of San Angelo IncCCN 451532, TX, NPI 1114001435

Change of ownership 1

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

Practitioners & affiliated clinicians

Practitioners 65

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 65

Affiliated clinicians 5

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": "1518134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1063911618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 HARTFORD ST",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796054603",
            "telephone_number": "325-793-3400",
            "fax_number": "325-793-3587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1933 UNIVERSITY AVE",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "76904",
            "telephone_number": "325-793-3400",
            "fax_number": "325-793-3587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WEST TEXAS REHABILITATION CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE WEST TEXAS REHABILITATION CENTER",
        "enumeration_date": "2018-02-09",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "325-793-3529"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospice of San Angelo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Angelo, TX

Sources for this page

Verify at the official NPI Registry.