NPIMap

Organization Active NPI

Throckmorton County Memorial Hosp

  • Critical Access Hospital
  • Throckmorton, TX
National Provider Identifier
1356418974
Registry record updated Dec 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
000428 Issued in TX
Legal business name
THROCKMORTON COUNTY MEMORIAL HOSP
Practice address
802 N Minter Ave
Throckmorton, TX 76483-5375
Phone
(940) 849-2151
Fax
(940) 849-7141
NPI assigned
Nov 29, 2006
Last updated
Dec 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2017

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

Authorized official

Name
Mr. Kirby Gober, DVM
Title
Ceo
Phone
(940) 849-2151

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 000428 TX Primary

Addresses

Primary practice location

802 N Minter Ave
Throckmorton, TX 76483-5375

Mailing address

802 N Minter Ave
PO Box 729
Throckmorton, TX 76483-5375
Phone (940) 849-2151

Other identifiers 1

IdentifierTypeStateIssuer
0881898-03MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040809000910 TX Part B Supplier - Clinic/Group Practice 4082686282 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Throckmorton, TX
O20041124000382 TX Part A Provider - Hospital 4082686282 1 other NPI on this enrollment
Practice locations: Throckmorton, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356418974. Details of each certification follow.

Hospital certification: CCN 451339

Legal name
THROCKMORTON COUNTY MEMORIAL HOSP
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
May 1, 2003
Last certification
Oct 19, 2016
Beds
14
Ownership / control type
Local
Organization structure
OtherNon-profit
Enrollment address
802 N. Minter Ave
Throckmorton, TX 76483-5357
Other Hospital Practice Location
Hospital subgroups
Acute care, Swing-bed approved

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Throckmorton County Memorial HospitalCCN 451339 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: cbeasley@throckmorton.direct.csshealthtech.com
  • Direct secure messaging: fkoberg@throckmorton.direct.csshealthtech.com
  • Direct secure messaging: rking@throckmorton.direct.csshealthtech.com
  • Direct secure messaging: tcurvin@throckmorton.direct.csshealthtech.com

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Karla Benson Individual W-2 Managing EmployeeBusiness Office Manager Nov 1, 2013
Kirby Gober Individual Corporate OfficerCeo Jun 20, 2014
Throckmorton County Memorial Hosp Organization, Throckmorton, TX Non-profit Operational/Managerial Control Nov 12, 2010

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Throckmorton County Memorial HospThrockmorton, TX, CCN 45Z339 Hospital Operational/Managerial Control Nov 12, 2010
Throckmorton Rural Health ClinicThrockmorton, TX, CCN 458683 Rural health clinic Operational/Managerial Control Jun 29, 2010

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 4

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.

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512950400000",
    "number": "1356418974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 N MINTER AVE",
            "address_2": "PO BOX 729",
            "city": "THROCKMORTON",
            "state": "TX",
            "postal_code": "764835375",
            "telephone_number": "940-849-2151",
            "fax_number": "940-849-7141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 N MINTER AVE",
            "city": "THROCKMORTON",
            "state": "TX",
            "postal_code": "764835375",
            "telephone_number": "940-849-2151",
            "fax_number": "940-849-7141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THROCKMORTON COUNTY MEMORIAL HOSP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2017-12-11",
        "status": "A",
        "authorized_official_last_name": "GOBER",
        "authorized_official_first_name": "KIRBY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "940-849-2151",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DVM"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "TX",
            "license": "000428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0881898-03",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Throckmorton, TX

Sources for this page

Verify at the official NPI Registry.