NPIMap

Organization Active NPI

East Texas Medical Center-Gilmer

  • General Acute Care Hospital
  • Gilmer, TX
National Provider Identifier
1295719227
Registry record updated Mar 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
008068 Issued in TX
Legal business name
EAST TEXAS MEDICAL CENTER-GILMER
Practice address
712 N Wood St
Gilmer, TX 75644-1751
Phone
(903) 841-7100
Fax
(903) 946-5531
NPI assigned
Dec 2, 2005
Last updated
Mar 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2014

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

Authorized official

Name
Mr. Tambri L Rolston
Title
Regional Director of Business Ser
Phone
(903) 946-5500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 008068 TX Primary

Addresses

Primary practice location

712 N Wood St
Gilmer, TX 75644-1751

Mailing address

P.O. Box 1304
Pittsburg, TX 75686-2203
Phone (903) 946-5519

Other identifiers 6

IdentifierTypeStateIssuer
HH1051OtherTXBLUE CROSS
00C13VOtherTXPHYSICIAN BCBS
168447403MedicaidTX
0069NEOtherTXRHC GROUP BCBS
168447402MedicaidTX
168447401MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1295719227. Details of each certification follow.

Hospital certification: CCN 450070

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GILMER MEDICAL CENTER
Certification status
Terminated Voluntary: risk of involuntary termination, Sep 30, 1995
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1969
Last certification
May 20, 1993
Beds
46
Ownership / control type
Church
Facility address
712 North Wood Street
Gilmer, TX 75644

Hospital certification: CCN 450884

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
EAST TEXAS MEDICAL CENTER - GILMER
Certification status
Terminated Voluntary: merger or closure, Oct 31, 2014
Provider type (POS)
Hospital – Short-term
Participating since
Jun 24, 2004
Last certification
Jun 22, 2011
Beds
37
Ownership / control type
Private (not for profit)
Facility address
712 North Wood
Gilmer, TX 75644

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394496000000",
    "number": "1295719227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1304",
            "city": "PITTSBURG",
            "state": "TX",
            "postal_code": "756862203",
            "telephone_number": "903-946-5519",
            "fax_number": "903-946-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 N WOOD ST",
            "city": "GILMER",
            "state": "TX",
            "postal_code": "756441751",
            "telephone_number": "903-841-7100",
            "fax_number": "903-946-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER-GILMER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-02",
        "last_updated": "2014-03-11",
        "status": "A",
        "authorized_official_last_name": "ROLSTON",
        "authorized_official_first_name": "TAMBRI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR OF BUSINESS SER",
        "authorized_official_telephone_number": "903-946-5500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TX",
            "license": "008068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "HH1051",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN BCBS",
            "identifier": "00C13V",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168447403",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RHC GROUP BCBS",
            "identifier": "0069NE",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168447402",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168447401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilmer, TX

Sources for this page

Verify at the official NPI Registry.