NPIMap

Organization Active NPI

Comanche County Medical Center Company

Doing business as Rising Star Rural Health Clinic

  • Rural Health Clinic/Center
  • Rising Star, TX
National Provider Identifier
1134720931
Registry record updated Feb 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COMANCHE COUNTY MEDICAL CENTER COMPANY
Doing business as
Rising Star Rural Health Clinic
Practice address
1870 State Hwy 36
Rising Star, TX 76471
Phone
(254) 879-4900
Fax
(254) 879-4991
NPI assigned
Nov 6, 2020
Last updated
Feb 22, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
COMANCHE COUNTY MEDICAL CENTER COMPANYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 22, 2021

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

Authorized official

Name
Nikki Stark
Title
Director of Clinic Operations
Phone
(254) 879-4910

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

1870 State Hwy 36
Rising Star, TX 76471

Mailing address

10201 Highway 16
Comanche, TX 76442-4462
Phone (254) 879-4900

Other names 1

  • Rising Star Rural Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210520000859 TX Part A Provider - Rural Health Clinic 4385552413 Practice locations: Rising Star, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134720931. Details of each certification follow.

Rural health clinic certification: CCN 678555

Legal name
COMANCHE COUNTY MEDICAL CENTER COMPANY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 13, 2021
Last certification
Jun 20, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2011 in TX
Enrollment address
1870 State Highway 36
Rising Star, TX 76471
Related CCNs
451382

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

Other NPIs with the same Medicare PAC ID 5

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

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
45D2217187Comanche County Medical Center1870 State Hwy 36, Rising Star, TX 76471Certificate of waiverMar 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Comanche County Med Ctr7 organizations share this tax ID, including this one
Part of
Comanche County Med Ctr

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the 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
Hong C Wade Individual Corporate OfficerCfo Dec 9, 2019
Daniel Bonk Individual Corporate OfficerCeo Sep 21, 2025
W-2 Managing EmployeeCeo Sep 21, 2025
Comanche County Medical Center Company Organization, Comanche, TX Non-profit Operational/Managerial Control Apr 1, 2021

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Comanche County Medical CenterComanche, TX, CCN 451382 Hospital 5% Or Greater Direct Ownership Interest Nov 1, 2011

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

NPI Registry JSON

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

{
    "created_epoch": "1604620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613952000000",
    "number": "1134720931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10201 HIGHWAY 16",
            "city": "COMANCHE",
            "state": "TX",
            "postal_code": "764424462",
            "telephone_number": "254-879-4900",
            "fax_number": "254-879-4991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1870 STATE HWY 36",
            "city": "RISING STAR",
            "state": "TX",
            "postal_code": "76471",
            "telephone_number": "254-879-4900",
            "fax_number": "254-879-4991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMANCHE COUNTY MEDICAL CENTER COMPANY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMANCHE COUNTY MEDICAL CENTER COMPANY",
        "enumeration_date": "2020-11-06",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A",
        "authorized_official_last_name": "STARK",
        "authorized_official_first_name": "NIKKI",
        "authorized_official_title_or_position": "DIRECTOR OF CLINIC OPERATIONS",
        "authorized_official_telephone_number": "254-879-4910"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rising Star Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rising Star Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rising Star, TX

Sources for this page

Verify at the official NPI Registry.