NPIMap

Organization Active NPI

Rehabilitation Hospital, LLC

  • Rehabilitation Hospital
  • Tyler, TX
National Provider Identifier
1174021695
Registry record updated Oct 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation HospitalTaxonomy code 283X00000X
Legal business name
REHABILITATION HOSPITAL, LLC
Practice address
701 Olympic Plaza Cir
Tyler, TX 75701-1950
Phone
(903) 596-3000
NPI assigned
Jan 30, 2018
Last updated
Oct 1, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
AHS EAST TEXAS HEALTH SYSTEM LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2023

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

Authorized official

Name
Stephen C Petrovich
Title
Evp
Phone
(615) 296-3000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X NU
Rehabilitation Hospital 283X00000X NU Primary
Cardiac Rehabilitation Registered Nurse 163WC3500X NU

Addresses

Primary practice location

701 Olympic Plaza Cir
Tyler, TX 75701-1950

Mailing address

340 Seven Springs Way Ste 100
Brentwood, TN 37027-5697
Phone (615) 296-3000

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180504001332 TX Part A Provider - Hospital 8123382835 Practice locations: Athens, TX; Whitehouse, TX; Tyler, TX; Rusk, TX; Pittsburg, TX; Mineola, TX; Lindale, TX; Jacksonville, TX…
O20191023003300 TX Part B Supplier - Intensive Cardiac Rehabilitation 8123382835 Receives reassigned benefits from 1 practitioner
Practice locations: Tyler, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174021695. Details of each certification follow.

Hospital certification: CCN 453072

Legal name
REHABILITATION HOSPITAL, LLC
Doing business as
UT HEALTH EAST TEXAS REHABILITATION HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Rehabilitation
Participating since
Aug 10, 1995
Last certification
Dec 17, 2021
Beds
49
Ownership / control type
Private (for profit)
Most recent change of ownership
Mar 1, 2018 (1 total)
Organization structure
LLCProprietary
Incorporated
Dec 19, 2017 in DE
Enrollment address
701 Olympic Plaza Cir
Tyler, TX 75701-1950
Main/Primary Hospital Location
Hospital subgroups
Rehabilitation

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Ut Health East Texas Rehabilitation HospitalCCN 453072 · All quality measures
Ownership
For profit
Certified
Aug 10, 1995
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

237 S Trade Days Blvd
Canton, TX 75103
Phone (903) 567-5966

400 E State Highway 243
Ste 21
Canton, TX 75103
Phone (903) 567-5966

400 E State Highway 243
Ste 22
Canton, TX 75103
Phone (903) 567-5966

218 N Shelby St
Carthage, TX 75633
Phone (903) 690-0021

123 State Highway 31 E
Chandler, TX 75758
Phone (903) 849-4404

103 E Marshall St
Gilmer, TX 75644
Phone (903) 843-2256

110 Municipal Dr
Gun Barrel City, TX 75156
Phone (903) 713-1555

414 S Main St
Jacksonville, TX 75766
Phone (903) 541-5520

1616 N Pacific St
Ste 2
Mineola, TX 75773
Phone (903) 569-0842

601 Highway 110 N
Ste N
Whitehouse, TX 75791
Phone (903) 596-3981

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Ardent Health Inc Organization, Brentwood, TN LLC 5% Or Greater Indirect Ownership Interest Mar 1, 2018 100%
Ahs Texas, LLC Organization, Brentwood, TN LLC 5% Or Greater Indirect Ownership Interest Jan 1, 2019 100%
Martin Bonick Individual Corporate OfficerCeo-Chain Office Sep 1, 2021
Mary a Crabtree Individual Corporate OfficerSVP Treasurer Mar 1, 2018
Ahs Management Company Inc. Organization, Brentwood, TN Corporation, Chain home office Operational/Managerial Control Mar 1, 2018
Stephen C Petrovich Individual Corporate OfficerEvp General Counsel Mar 1, 2018
Ahs East Texas Health System, LLC Organization, Brentwood, TN LLC 5% Or Greater Direct Ownership Interest Mar 1, 2018 100%
Donald Baker Individual Corporate OfficerCeo Sep 1, 2021 100%
W-2 Managing EmployeeCeo Sep 1, 2021 100%
Ahp Health Partners, Inc Organization, Brentwood, TN Corporation 5% Or Greater Indirect Ownership Interest Mar 1, 2018

Facilities with the same owner 60

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

  • Athens Hospital, LLC
    • General Acute Care Hospital
    • Athens, TX
    • NPI 1417465824

    Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc

    CMS ownership
  • Bsa Hospital LLC
    • General Acute Care Hospital
    • Amarillo, TX
    • NPI 1407191984

    Ahp Health Partners, Inc, Ahs Management Company Inc., Ardent Health Inc

    CMS ownership
  • Bsa Hospital LLC
    • Rehabilitation Hospital Unit
    • Amarillo, TX
    • NPI 1730425190

    Ahp Health Partners, Inc, Ahs Management Company Inc., Ardent Health Inc

    CMS ownership
  • Carthage Hospital, LLC
    • Rural Health Clinic/Center
    • Carthage, TX
    • NPI 1407355860

    Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc

    CMS ownership
  • Carthage Hospital, LLC
    • General Acute Care Hospital
    • Carthage, TX
    • NPI 1538667035

    Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc

    CMS ownership
  • Carthage Hospital, LLC
    • Rural Health Clinic/Center
    • Carthage, TX
    • NPI 1639678030

    Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc

    CMS ownership
  • Encompass Health Rehabilitation Hospital of Amarillo, LLC

    dba Rehabilitation Hospital of Amarillo

    • Rehabilitation Hospital
    • Amarillo, TX
    • NPI 1487443099

    Ahp Health Partners, Inc, Ardent Health Inc

    CMS ownership
  • Etmc Physician Group Inc.
    • Rural Health Clinic/Center
    • Chandler, TX
    • NPI 1235706581

    Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc

    CMS ownership
  • Etmc Physician Group Inc.
    • Rural Health Clinic/Center
    • Gun Barrel City, TX
    • NPI 1689241945

    Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc

    CMS ownership
  • Henderson Hospital, LLC

    dba UTHealth East Texas Henderson Hospital

    • General Acute Care Hospital
    • Henderson, TX
    • NPI 1326546797

    Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc

    CMS ownership
  • Henderson Hospital, LLC
    • Rural Health Clinic/Center
    • Henderson, TX
    • NPI 1952800310

    Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc

    CMS ownership
  • HH Killeen Health System LLC

    dba Seton Medical Center Harker Heights

    • General Acute Care Hospital
    • Harker Heights, TX
    • NPI 1841562709

    Ahp Health Partners, Inc, Ahs Management Company Inc., Ardent Health Inc

    CMS ownership
View all 60

Practitioners & affiliated clinicians

Practitioners 6

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 226

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

View all 226

NPI Registry JSON

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

{
    "created_epoch": "1517270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696118400000",
    "number": "1174021695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 SEVEN SPRINGS WAY STE 100",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275697",
            "telephone_number": "615-296-3000",
            "fax_number": "615-296-6227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 OLYMPIC PLAZA CIR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011950",
            "telephone_number": "903-596-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REHABILITATION HOSPITAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AHS EAST TEXAS HEALTH SYSTEM LLC",
        "enumeration_date": "2018-01-30",
        "last_updated": "2023-10-01",
        "certification_date": "2023-10-01",
        "status": "A",
        "authorized_official_last_name": "PETROVICH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EVP",
        "authorized_official_telephone_number": "615-296-3000"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "163WC3500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Cardiac Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.