NPIMap

Organization Active NPI

Pershing General Hospital

  • Rural Health Clinic/Center
  • Lovelock, NV
National Provider Identifier
1124110317
Registry record updated Dec 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
655HOS-11 Issued in NV
Legal business name
PERSHING GENERAL HOSPITAL
Practice address
855 6TH St.
Lovelock, NV 89419-0661
Phone
(775) 273-2621
Fax
(775) 273-5183
NPI assigned
Sep 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2019

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

Authorized official

Name
Mr. Cynthia Hixenbaugh
Title
Ceo
Phone
(775) 273-2621

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 655HOS-11 NV Primary

Addresses

Primary practice location

855 6TH St.
Lovelock, NV 89419-0661

Mailing address

PO Box 661
855 6TH Street
Lovelock, NV 89419-0661
Phone (775) 273-2621

Other identifiers 1

IdentifierTypeStateIssuer
001514002MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20021111000028 NV Part A Provider - Rural Health Clinic 7012825433 Practice locations: Lovelock, NV
O20070216000077 NV Part A Provider - Critical Access Hospital 7012825433 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lovelock, NV

Rural health clinic certification: CCN 293981

Legal name
PERSHING GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 11, 2003
Last certification
Aug 24, 2015
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Sep 14, 1984 in NV
Enrollment address
850 6TH St
Lovelock, NV 89419-8020
Related CCNs
291304

Hospital certification: CCN 291304

Legal name
PERSHING GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Apr 1, 2001
Last certification
Jun 19, 2025
Beds
17
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Enrollment address
855 6TH Street
Lovelock, NV 89419-0661
Other Hospital Practice Location

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.

Care Compare: Hospital

Medicare Care Compare
Listed as
Pershing General HospitalCCN 291304
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D1007454Pershing General Hospital Physician'S Center850 6TH St Ste 101, Lovelock, NV 89419Provider-performed microscopyAug 27, 2027

National Provider Directory

National Provider Directory

Locations

10791 Double R Blvd
Reno, NV 89521
Phone (775) 284-2020

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/persgen-94663ea1

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Debora Mock Individual Corporate OfficerRevenue Cycle Manager Apr 26, 2013
W-2 Managing Employee Oct 26, 2010
W-2 Managing EmployeeRevenue Cycle Manager Nov 20, 2015
Lynn Broyles Individual Corporate OfficerCfo Jan 1, 2024
W-2 Managing EmployeeCfo Jan 1, 2024
Operational/Managerial ControlCfo Jan 1, 2024
Marci Carruth Individual Corporate DirectorBoard Member Jan 8, 2025
Dana Tueller Individual Corporate DirectorBoard Trustee Feb 1, 2013 100%
Corporate DirectorBoard Secretary Jan 1, 2015
Ted Bendure Individual Corporate DirectorBoard Trustee Feb 7, 2017 100%
Corporate DirectorVice Chairman Jan 1, 2022
Brandon Chadock Individual Corporate OfficerCeo Aug 29, 2022 100%
Operational/Managerial ControlCeo Aug 29, 2022 100%
Corporate OfficerCeo Aug 29, 2022
W-2 Managing EmployeeCeo Aug 29, 2022
Operational/Managerial ControlCeo Aug 29, 2022
Sondra Sayles Individual Corporate DirectorBoard Member Oct 1, 2024
Raylene Stiehl Individual Corporate OfficerCno Jan 1, 2024
W-2 Managing EmployeeCno Jan 1, 2024
Operational/Managerial ControlCno Jan 1, 2024
Pershing General Hospital Organization, Lovelock, NV Created for acquisition 5% Or Greater Direct Ownership Interest May 7, 1984 100%
Kamin B Vanguilder Individual Corporate OfficerMedical Director Oct 1, 2024
W-2 Managing EmployeeMD; Oct 1, 2024
Operational/Managerial ControlMedical Director Oct 1, 2024
Corporate DirectorMedical Director Jul 31, 2024
W-2 Managing EmployeeMD; Jul 31, 2024
Phillip Dickerman Individual Corporate DirectorBoard Member Jan 1, 2022
Jayce Montes Individual Corporate DirectorBoard Member Jan 1, 2022

Owners & managing parties with NPI records 4

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
Pershing General HospitalLovelock, NV, CCN 291304 Hospital 5% Or Greater Direct Ownership Interest (100%) May 7, 1984
Pershing General HospitalLovelock, NV, CCN 29Z304 Hospital 5% Or Greater Direct Ownership Interest (100%) May 7, 1984
Pershing General SNFLovelock, NV, CCN 295000 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 May 7, 1984
May 7, 1984

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 6

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

Affiliated clinicians 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575417600000",
    "number": "1124110317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 661",
            "address_2": "855 6TH STREET",
            "city": "LOVELOCK",
            "state": "NV",
            "postal_code": "894190661",
            "telephone_number": "775-273-2621",
            "fax_number": "775-273-5183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 6TH ST.",
            "city": "LOVELOCK",
            "state": "NV",
            "postal_code": "894190661",
            "telephone_number": "775-273-2621",
            "fax_number": "775-273-5183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSHING GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2019-12-04",
        "status": "A",
        "authorized_official_last_name": "HIXENBAUGH",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "775-273-2621",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NV",
            "license": "655HOS-11",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001514002",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lovelock, NV

Sources for this page

Verify at the official NPI Registry.