Hospice Brazos Valley, Inc.
Organization Active NPI Community Based Hospice Care Agency · Bryan, TX
NPI 1245232149 · NPPES record last updated Dec 13, 2022
Key facts
- NPI
- 1245232149
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 2186 (TX)
- Legal business name
- HOSPICE BRAZOS VALLEY, INC.
- Practice address
- 502 W 26TH St
Bryan, TX 77803-2426 - Phone
- (979) 821-2266
- Fax
- (979) 821-2763
- NPI assigned
- Aug 11, 2005
- Organization subpart
- No
Authorized official
- Name
- Mrs. Lisa McNair
- Title
- President/Ceo
- Phone
- (979) 821-2266
Owners & managing parties with NPI records 1
-
Thomas O Borgstedte, D.O.
Subparts reporting this organization as parent 1
Practitioners 7
-
Mindy Dawn Coakley, AGNP
-
John Steven Moore, M.D., M.P.H.
-
Jennifer Elaine Nordhauser, MD, MPH
-
Melody Scarbrough, APRN-FNP-BC
Affiliated clinicians 14
-
Eric N Alford, MD
-
Wess James Blackwell, M.D.
-
Katherine E Blalock, M.D.
-
Thomas O Borgstedte, D.O.
-
Jacquelyn Rose Covington, M.D.
-
Amy Jean Gutierrez, M.D.
-
Peter Jian, M.D.
-
Jeffrey E Kalina, M.D.
-
William Robert Loesch, M.D.
-
Jacques Mamigonian, M.D.
-
Diana L Stone, D.O.
-
Gregg A Workman, MD
Medicare Care Compare: Hospice
- Listed as
- Hospice Brazos Valley Inc
- Ownership
- For-Profit
- Certified
- Apr 10, 1991
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Hospice certification: CCN 451547
- Legal name
- HOSPICE BRAZOS VALLEY INC.
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Apr 10, 1991
- Last certification
- Oct 22, 2021
- Ownership / control type
- Non-Profit - Private
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 23, 1981 in TX
- Enrollment address
- 502 W 26TH Street
Bryan, TX 77803-2426
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Thomas Owen Borgstedte |
Contracted Managing Employee |
Aug 1, 2007 | |
| Lisa McNair |
Corporate Director | Jan 1, 2022 | |
| W-2 Managing Employee |
Jan 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060727000196 | TX | Part a Provider - Hospice | 9234142829 | Practice locations: Bryan, TX |
National Provider Directory
Locations
4107 Spicewood Springs Rd
Austin, TX 78759
Phone (512) 342-4700
302 E Blue Bell Rd
Brenham, TX 77833
Phone (979) 277-9525
502 W 26th St
Bryan, TX 77803
Phone (979) 821-2266
1048 N Jefferson St
La Grange, TX 78945
Phone (979) 968-6913
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 2186 | TX | Yes |
Addresses
Primary practice location
502 W 26TH St
Bryan, TX 77803-2426
Mailing address
502 W 26TH St
Bryan, TX 77803-2426
Phone (979) 821-2266
Other practice location 1
1048 N Jefferson St
LA Grange, TX 78945-1210
Phone (979) 968-6913
Other practice location 2
302 E Blue Bell Rd
Brenham, TX 77833-2406
Phone (979) 277-9525
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2037 | Medicaid | TX | |
| 2186 | Other | TX | DEPT OF AGING |
Other providers in Bryan, TX
- Davelyn Eaves Hood
- Jason Marshall Hoover
- Kassidy Lynn Hopkins
- Hurb A Hosea
- Hospice Brazos Valley, Inc.
- Hospitalist Medicine Physicians of Texas - Livingston, PLLC
- Samiyah Hossain
- Edward Patrick Houser
- Kuy Houser
- Cameron Hoverson
All providers in Bryan, TX · Community Based Hospice Care Agency in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.