South Plains Rural Health Services, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Levelland, TX
NPI 1295746402 · NPPES record last updated Dec 29, 2023
Key facts
- NPI
- 1295746402
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SOUTH PLAINS RURAL HEALTH SERVICES, INC.
- Practice address
- 1000 FM 300
Levelland, TX 79336-6235 - Phone
- (806) 894-7842
- Fax
- (806) 894-3378
- NPI assigned
- Aug 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Judith Marie Madura, M.D.
- Title
- Chief Executive Officer
- Phone
- (806) 894-7842
Owners & managing parties with NPI records 1
-
Judith M Madura, MD
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 2
Practitioners 20
-
Kristy Rocio Acosta, M.D.
-
Petros Kosmas Chapanos, M.D.
-
Rachel Anne Eagan, LPC-S
-
Amy Leigh Elliott, FNP-BC
-
Beatriz Flores Garza, FNP
-
Dolly Kay Gutierrez, RN, MSN, FNP-C
-
Jeanette Michelle Hastings, FNP-BC
-
Susan Kay Lance, APRN, FNP-C
-
Judith M Madura, MD
-
Delanie McElroy, MSN, APRN, FNP-C
-
Katrina Petrowski, FNP-C
-
Vicky Lee Quilantan, MSN, FNP- BC
-
Lance M Tolbert, LPC
-
Robbie Adams Tutunjian, APRN-CNP
-
Kelsey McMurry, FNP
-
Shima N/a Setork, DMD
-
Mary Leslie Womack, DDS
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D0709462 | South Plains Rural Health Services Inc | Provider-performed microscopy | Jun 29, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Federally qualified health center certification: CCN 451846
- Legal name
- SOUTH PLAINS RURAL HEALTH SERVICES INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 1991
- Last certification
- Oct 1, 1991
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 11, 1986 in TX
- Enrollment address
- 1000 FM 300
Levelland, TX 79336-6235
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Janie Velez |
Corporate Director |
May 18, 2009 | |
| Joann Staulcup |
Corporate Director |
Jul 19, 2010 | |
| Juanita Rios |
Corporate Director |
Apr 7, 2008 | |
| Maureen Reyes |
Corporate Director |
Dec 16, 2006 | |
| Cynthia Camacho |
W-2 Managing Employee |
Jun 11, 2015 | |
| Tara Haskell |
Corporate Officer |
Apr 29, 2014 | |
| W-2 Managing Employee |
Jun 11, 2015 | ||
| Janie Corrales |
Corporate Director |
Jan 5, 2015 | |
| Virginia Belew |
Corporate Director |
Jan 27, 2014 | |
| Judith Marie Madura |
Corporate Officer |
Jul 12, 2006 | |
| W-2 Managing Employee |
Jun 11, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030717000013 | TX | Part a Provider - Federally Qualified Health Center (FQHC) | 4880505726 | Practice locations: Levelland, TX |
| O20040610000024 | TX | Part B Supplier - Clinic/Group Practice | 4880505726 |
Receives reassigned benefits from 20 practitioners 2 other NPIs on this enrollment Practice locations: Big Spring, TX; Lamesa, TX; Levelland, TX |
National Provider Directory
Locations
1502 N Avenue K
Lamesa, TX 79331
Phone (806) 872-3069
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1000 FM 300
Levelland, TX 79336-6235
Mailing address
1000 FM 300
Levelland, TX 79336-6235
Phone (806) 894-7842
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121513902 | Medicaid | TX | |
| 082907901 | Medicaid | TX |
Other names
- South Plains Rural Health Services, Inc.
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | tashmore@sprhs.org | South Plains Rural Health Services, Inc. |
Other providers in Levelland, TX
- South Plains Community Action Association, Inc.
- South Plains Community Action Association, Inc.
- South Plains Community Action Association, Inc.
- South Plains Rural Health Services Inc
- South Plains Rural Health Services Inc
- George Gardner Stewart
- Christopher Straface
- Laura Anne Terry
- Robby Don Timberlake
- Lance M Tolbert
All providers in Levelland, TX · Federally Qualified Health Center (FQHC) 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 29, 2023. 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.