NPIMap

Organization Active NPI

Fisher County Hospital District

Doing business as Clearfork Health Center

  • Rural Health Clinic/Center
  • Rotan, TX
National Provider Identifier
1104808112
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FISHER COUNTY HOSPITAL DISTRICT
Doing business as
Clearfork Health Center
Practice address
774 State Hwy 70 N
Rotan, TX 79546-6918
Phone
(325) 735-2211
Fax
(325) 735-2240
NPI assigned
Nov 16, 2005
Last updated
Jun 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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

Authorized official

Name
Caleb White
Title
Cfo
Phone
(325) 735-2256

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

774 State Hwy 70 N
Rotan, TX 79546-6918

Mailing address

774 State Hwy 70 N
Rotan, TX 79546-6918
Phone (325) 735-2211

Other identifiers 2

IdentifierTypeStateIssuer
108080602MedicaidTX
0015DJOtherTXBCBS GROUP PROVIDER NUMBER

Other names 1

  • Clearfork Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040315000096 TX Part B Supplier - Clinic/Group Practice 2163311465 Receives reassigned benefits from 112 practitioners
1 other NPI on this enrollment
Practice locations: Rotan, TX
O20060216000293 TX Part A Provider - Rural Health Clinic 2163311465 Practice locations: Rotan, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104808112. Details of each certification follow.

Rural health clinic certification: CCN 458779

Legal name
FISHER COUNTY HOSPITAL DISTRICT
Doing business as
CLEARFORK HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 9, 1993
Last certification
Oct 25, 2022
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
774 State Highway 70 North
Rotan, TX 79546-6918
Related CCNs
451313

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Fisher County Hospital District Organization, Rotan, TX Non-profit 5% Or Greater Direct Ownership Interest Feb 20, 1998 100%
Carey Leanne Martinez Individual Corporate OfficerCeo Aug 30, 2017
W-2 Managing EmployeeCeo Aug 30, 2017
Caleb White Individual Corporate OfficerCfo Apr 30, 2022

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 119

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 119

NPI Registry JSON

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1104808112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "774 STATE HWY 70 N",
            "city": "ROTAN",
            "state": "TX",
            "postal_code": "795466918",
            "telephone_number": "325-735-2211",
            "fax_number": "325-735-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "774 STATE HWY 70 N",
            "city": "ROTAN",
            "state": "TX",
            "postal_code": "795466918",
            "telephone_number": "325-735-2211",
            "fax_number": "325-735-2240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FISHER COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-16",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "CALEB",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "325-735-2256"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108080602",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS  GROUP PROVIDER NUMBER",
            "identifier": "0015DJ",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clearfork Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rotan, TX

Sources for this page

Verify at the official NPI Registry.