NPIMap

Organization Active NPI

Jackson County Hospital District

  • Critical Access Hospital
  • Edna, TX
National Provider Identifier
1124061882
Registry record updated Oct 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
000017 Issued in TX
Legal business name
JACKSON COUNTY HOSPITAL DISTRICT
Practice address
1013 South Wells Street
Edna, TX 77957-4098
Phone
(361) 782-5241
Fax
(361) 782-5241
NPI assigned
Jun 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2009

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

Authorized official

Name
Mr. Asa B Wilson
Title
Administrator/Ceo
Phone
(361) 782-5241

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 000017 TX Primary

Addresses

Primary practice location

1013 South Wells Street
Edna, TX 77957-4098

Mailing address

1013 South Wells Street
Edna, TX 77957-4098
Phone (361) 782-5241

Other identifiers 1

IdentifierTypeStateIssuer
121808305MedicaidTX

Other names 1

  • Jackson HealthCare Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000401 TX Part A Provider - Critical Access Hospital 2365423795 Receives reassigned benefits from 20 practitioners
Practice locations: Edna, TX

Hospital certification: CCN 451363

Legal name
JACKSON COUNTY HOSPITAL DISTRICT
Doing business as
JACKSON HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Mar 1, 2005
Last certification
Jan 25, 2024
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
OtherProprietary
Incorporated
Jan 1, 2005 in TX
Enrollment address
1013 South Wells Street
Jackson Healthcare Center
Edna, TX 77957-4098

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
Jackson Healthcare CenterCCN 451363
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Edna Family Practice12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Jackson County Hospital District Organization, Edna, TX 5% Or Greater Direct Ownership Interest Jan 1, 2005 100%
Lance Smiga Individual Corporate DirectorCfo Jul 1, 2012
W-2 Managing EmployeeCfo Jul 1, 2012
William Jones Individual Corporate DirectorCeo Oct 27, 2010
W-2 Managing EmployeeCeo Oct 27, 2010
Paula Gabrysch Individual Corporate DirectorSupervisor Oct 27, 2010
W-2 Managing EmployeeSupervisor Oct 27, 2010

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
Jackson Healthcare CenterEdna, TX, CCN 45Z363 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 2005
Jackson County Home HealthEdna, TX, CCN 677103 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 31, 2011
Oct 31, 2011
Jackson County Medical Clinic of EdnaEdna, TX, CCN 458736 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2005
Jackson County Medical Clinic of GanadoGanado, TX, CCN 673495 Rural health clinic Operational/Managerial Control Oct 1, 2025

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 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 31

Affiliated clinicians 91

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

View all 91

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256601600000",
    "number": "1124061882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 SOUTH WELLS STREET",
            "city": "EDNA",
            "state": "TX",
            "postal_code": "779574098",
            "telephone_number": "361-782-5241",
            "fax_number": "361-782-5241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 SOUTH WELLS STREET",
            "city": "EDNA",
            "state": "TX",
            "postal_code": "779574098",
            "telephone_number": "361-782-5241",
            "fax_number": "361-782-5241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2009-10-27",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ASA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "361-782-5241",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "TX",
            "license": "000017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121808305",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson HealthCare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edna, TX

Sources for this page

Verify at the official NPI Registry.