NPIMap

Organization Active NPI

Sid Peterson Memorial Hospital

Doing business as Peterson Home Care

  • Home Health Agency
  • Kerrville, TX
National Provider Identifier
1073582656
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
002114 Issued in TX
Legal business name
SID PETERSON MEMORIAL HOSPITAL
Doing business as
Peterson Home Care
Practice address
250 Cully Dr
Kerrville, TX 78028-5950
Phone
(830) 258-7400
Fax
(830) 896-5859
NPI assigned
Mar 16, 2006
Last updated
Jul 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2022

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

Authorized official

Name
Lisa Medovich
Title
Chief Financial Officer
Phone
(830) 258-7632

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 002114 TX Primary

Addresses

Primary practice location

250 Cully Dr
Kerrville, TX 78028-5950

Mailing address

551 Hill Country Dr
Kerrville, TX 78028-6085
Phone (830) 257-3111

Other identifiers 2

IdentifierTypeStateIssuer
002114OtherTXTEXAS HEALTH AND HUMAN SERVICES COMMISSION
091526602MedicaidTX

Other names 1

  • Peterson Home Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070508000223 TX Part A Provider - Home Health Agency 6002724887 Practice locations: Kerrville, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073582656. Details of each certification follow.

Home health agency certification: CCN 677052

Legal name
SID PETERSON MEMORIAL HOSPITAL
Doing business as
PETERSON HOME CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 8, 1986
Last certification
Mar 29, 2019
Ownership / control type
Non-Profit
Organization structure
OtherNon-profit
Incorporated
Feb 13, 1989 in TX
Enrollment address
250 Cully Dr
Kerrville, TX 78028-5950
HHA Branch

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Peterson Home CareCCN 677052 · All quality measures
Overall star rating
3.5 of 5
Ownership
Non-Profit
Certified
Jul 8, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Peterson Home Care6 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 17

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

NameRoleSinceShare
Gaye Avery Individual Corporate OfficerBoard Member Jul 1, 2024
Michael D Ross Individual Corporate OfficerBoard Member Jul 1, 2024
Norman Williams Individual Corporate Director Jul 1, 2022
Toni Manchester Individual Corporate Director Jul 1, 2022
Rose Bradshaw Individual Corporate Director Jul 1, 2022
James a Young Individual Contracted Managing EmployeeMedical Director Jul 1, 2020
Lisa M Medovich Individual Corporate OfficerCfo Jul 1, 2016
W-2 Managing EmployeeCfo Jul 1, 2016
Brian P Bowers Individual Corporate DirectorBoard Member Jul 1, 2019
Sid Peterson Memorial Hospital Organization, Kerrville, TX Non-profit Operational/Managerial Control Feb 13, 2007
Kaylah King Individual W-2 Managing EmployeeAdministrator Jan 1, 2024
Joseph Thomas Piszczor Individual Corporate OfficerCoo Jul 14, 2020
W-2 Managing Employee Jul 14, 2020
Jeremy Walther Individual Corporate DirectorBoard Member Jul 1, 2024
Kendall Davison Individual Corporate DirectorBoard Member Jul 1, 2023
Johnathan W McDonald Individual Corporate OfficerPresident/Ceo May 27, 2025
W-2 Managing EmployeePresident/Ceo May 27, 2025
Christopher Ballesteros Individual W-2 Managing EmployeeCompliance Officer Jul 1, 2019
Thomas Houdeshell Individual Corporate DirectorBoard Member Jul 1, 2020
Kristen McAlexander 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 4

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

FacilityTypeRoleSince
Peterson Community Care Clinic RHCKerrville, TX, CCN 450007 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 1990
Jan 1, 1990
Peterson Regional Medical CenterKerrville, TX, CCN 45T007 Hospital Operational/Managerial Control Jan 1, 1990
Peterson HospiceKerrville, TX, CCN 671585 Hospice 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 26, 2007
Apr 26, 2007
Peterson Community Care Clinic RHCKerrville, TX, CCN 678558 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 1990
Jan 1, 1990

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 5

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.

Affiliated clinicians 47

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

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658880000000",
    "number": "1073582656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "551 HILL COUNTRY DR",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780286085",
            "telephone_number": "830-257-3111",
            "fax_number": "830-896-5859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 CULLY DR",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780285950",
            "telephone_number": "830-258-7400",
            "fax_number": "830-896-5859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SID PETERSON MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-16",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A",
        "authorized_official_last_name": "MEDOVICH",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "830-258-7632"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "002114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS HEALTH AND HUMAN SERVICES COMMISSION",
            "identifier": "002114",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "091526602",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peterson Home Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Peterson Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kerrville, TX

Sources for this page

Verify at the official NPI Registry.