NPIMap

Organization Active NPI

Falls Community Hospital and Clinic

  • Rural Health Clinic/Center
  • Rosebud, TX
National Provider Identifier
1194777540
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FALLS COMMUNITY HOSPITAL AND CLINIC
Practice address
312 N Stallworth
Rosebud, TX 76570-2254
Phone
(254) 803-3561
Fax
(254) 883-6066
NPI assigned
May 16, 2006
Organization subpart
Yes
Parent organization
FALLS COMMUNITY HOSPITAL AND CLINCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

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

Authorized official

Name
Mrs. Jessica Ford
Title
Interim Administrator
Phone
(254) 803-3561

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

312 N Stallworth
Rosebud, TX 76570-2254

Mailing address

PO Box 60
Marlin, TX 76661-0060
Phone (254) 803-3561

Other identifiers 1

IdentifierTypeStateIssuer
458870OtherTXPTAN

Other names 1

  • FCHC Rosebud Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060110000061 TX Part A Provider - Rural Health Clinic 8527959816 Practice locations: Rosebud, TX

Rural health clinic certification: CCN 458870

Legal name
FALLS COMMUNITY HOSPITAL AND CLINIC
Doing business as
FCHC-ROSEBUD MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 30, 2006
Last certification
May 1, 2018
Ownership / control type
2B
Organization structure
CorporationProprietary
Incorporated
Jun 3, 1960 in TX
Enrollment address
312 N Stallworth
FCHC Rosebud Medical Clinic`
Rosebud, TX 76570-2254
Related CCNs
450348

Other NPIs with the same Medicare PAC ID 4

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
45D1038697FCHC-Rosebud Medical Clinic312 North Stallworth, Rosebud, TX 76570Certificate of waiverMar 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Falls Community Hospita4 organizations share this tax ID, including this one
Part of
Falls Community Hospita

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Jessica Ford Individual Corporate OfficerAdministrator Jan 1, 2023
Corporate DirectorAdministrator Jan 1, 2023
W-2 Managing EmployeeAdministrator Jan 1, 2023
Tommy Pleasants Individual Corporate Director Jan 10, 2006
Laura Hubred Individual W-2 Managing EmployeeCredentialing Manager Feb 1, 2021
Ken Tomlinson Individual Corporate DirectorBoard President Jan 10, 2006
Falls Community Hospital and Clinic Organization, Marlin, TX Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2006 100%

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 1

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

FacilityTypeRoleSince
Falls Community Hospital and ClinicMarlin, TX, CCN 670780 Hospital 5% Or Greater Indirect Ownership Interest (20%) Apr 6, 2018

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.

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622592000000",
    "number": "1194777540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60",
            "city": "MARLIN",
            "state": "TX",
            "postal_code": "766610060",
            "telephone_number": "254-803-3561",
            "fax_number": "254-883-6066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 N STALLWORTH",
            "city": "ROSEBUD",
            "state": "TX",
            "postal_code": "765702254",
            "telephone_number": "254-803-3561",
            "fax_number": "254-883-6066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALLS COMMUNITY HOSPITAL AND CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FALLS COMMUNITY HOSPITAL AND CLINC",
        "enumeration_date": "2006-05-16",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "INTERIM ADMINISTRATOR",
        "authorized_official_telephone_number": "254-803-3561",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "458870",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FCHC Rosebud Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FCHC Rosebud Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rosebud, TX

Sources for this page

Verify at the official NPI Registry.