NPIMap

Organization Active NPI

Pecos County Memorial Hospital District

  • Critical Access Hospital
  • Fort Stockton, TX
National Provider Identifier
1073200309
Registry record updated Feb 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
PECOS COUNTY MEMORIAL HOSPITAL DISTRICT
Practice address
387 W Ih 10
Fort Stockton, TX 79735-2708
Phone
(432) 336-4201
Fax
(432) 336-4545
NPI assigned
Apr 18, 2023
Last updated
Feb 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2024

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

Authorized official

Name
Betsy L Briscoe
Title
Chief Executive Officer
Phone
(432) 336-4201

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X
Critical Access Hospital 282NC0060X Primary

Addresses

Primary practice location

387 W Ih 10
Fort Stockton, TX 79735-2708

Mailing address

387 W Ih 10
Fort Stockton, TX 79735-2708
Phone (432) 336-4201

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231003000027 TX Part A Provider - Critical Access Hospital 3173977477 Receives reassigned benefits from 47 practitioners
Practice locations: Fort Stockton, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073200309. Details of each certification follow.

Hospital certification: CCN 451389

Legal name
PECOS COUNTY MEMORIAL HOSPITAL DISTRICT
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Feb 24, 2017
Last certification
Nov 15, 2025
Beds
25
Ownership / control type
Local
Most recent change of ownership
Jul 1, 2023 (1 total)
Organization structure
OtherNon-profit
Enrollment address
387 W Ih 10
Fort Stockton, TX 79735
Main/Primary Hospital Location

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

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: Hospital

Medicare Care Compare
Listed as
Pecos County Memorial HospitalCCN 451389 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
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
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 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
Pecos County Memorial Hospital HospiceFort Stockton, TX, CCN 671732 Hospice 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2023
Jul 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.

Practitioners & affiliated clinicians

Practitioners 51

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 51

Affiliated clinicians 57

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

View all 57

NPI Registry JSON

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708300800000",
    "number": "1073200309",
    "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": "797352708",
            "telephone_number": "432-336-4201",
            "fax_number": "432-336-4545"
        },
        {
            "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": "797352708",
            "telephone_number": "432-336-4201",
            "fax_number": "432-336-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECOS COUNTY MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-18",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A",
        "authorized_official_last_name": "BRISCOE",
        "authorized_official_first_name": "BETSY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "432-336-4201"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Stockton, TX

Sources for this page

Verify at the official NPI Registry.