NPIMap

Organization Active NPI

Jack County Hospital District

Doing business as FCH Rural Health Clinic Graham

  • Rural Health Clinic/Center
  • Graham, TX
National Provider Identifier
1235737008
Registry record updated Oct 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JACK COUNTY HOSPITAL DISTRICT
Doing business as
FCH Rural Health Clinic Graham
Practice address
1005 State Highway 16 S
Graham, TX 76450-3835
Phone
(940) 282-2512
Fax
(940) 567-2895
NPI assigned
Oct 14, 2020
Last updated
Oct 14, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
JACK COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 14, 2020

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

Authorized official

Name
Mr. Frank L Beaman
Title
Ceo
Phone
(940) 567-6633

Specialties & licenses 1

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

Addresses

Primary practice location

1005 State Highway 16 S
Graham, TX 76450-3835

Mailing address

215 Chisholm TRL
Jacksboro, TX 76458-1403
Phone (940) 567-6633

Other names 1

  • FCH Rural Health Clinic Graham Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201021002250 TX Part A Provider - Rural Health Clinic 4587842315 Practice locations: Graham, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235737008. Details of each certification follow.

Rural health clinic certification: CCN 673497

Legal name
JACK COUNTY HOSPITAL DISTRICT
Doing business as
FCH RURAL HEALTH CLINIC GRAHAM
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 18, 2021
Last certification
Mar 18, 2021
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
1005 State Highway 16 S
Graham, TX 76450-3835
Related CCNs
450241

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).

National Provider Directory

National Provider Directory
Tax ID family
Faith Community Hosp14 organizations share this tax ID, including this one
Part of
Faith Community Hosp

Other organizations with this tax ID 13

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

View all 13

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

115 E Bypass 287
Alvord, TX 76225
Phone (940) 427-2858

501 N Main St
Collinsville, TX 76233
Phone (903) 429-6426

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
James Hammond Individual Corporate DirectorBoard Member Oct 14, 2020
Mark Maples Individual Corporate DirectorBoard Member Oct 13, 2020
Lori McBrayer Individual Corporate DirectorBoard Member Oct 15, 2020
Leslie Chalmers Individual Corporate Director Oct 14, 2020
Larry Hopwood Individual Corporate DirectorBoard Member Oct 14, 2020
Jack County Hospital District Organization, Jacksboro, TX 5% Or Greater Direct Ownership Interest Oct 14, 2020 100%
Operational/Managerial Control Oct 14, 2020
Kim Lee Individual Corporate DirectorChieffinancial Officer Oct 14, 2020
W-2 Managing EmployeeChief Financial Officer Oct 14, 2020
Frank L Beaman Individual Corporate DirectorChief Executive Officer Oct 14, 2020
W-2 Managing EmployeeChief Executive Officer Oct 14, 2020
Trina D Johnson Individual W-2 Managing EmployeeFinancial Analyst Oct 1, 2024

Owners & managing parties with NPI records 2

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

Facilities with the same owner 8

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": "1602633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602633600000",
    "number": "1235737008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 CHISHOLM TRL",
            "city": "JACKSBORO",
            "state": "TX",
            "postal_code": "764581403",
            "telephone_number": "940-567-6633",
            "fax_number": "940-567-2895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 STATE HIGHWAY 16 S",
            "city": "GRAHAM",
            "state": "TX",
            "postal_code": "764503835",
            "telephone_number": "940-282-2512",
            "fax_number": "940-567-2895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACK COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2020-10-14",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A",
        "authorized_official_last_name": "BEAMAN",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "940-567-6633",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FCH Rural Health Clinic Graham",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Graham, TX

Sources for this page

Verify at the official NPI Registry.