Scott & White Hospital - Marble Falls
Organization Active NPI Rural Health Clinic/Center · Marble Falls, TX
NPI 1376844936 · NPPES record last updated Oct 17, 2019
Key facts
- NPI
- 1376844936
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 100090 (TX)
- Legal business name
- SCOTT & WHITE HOSPITAL - MARBLE FALLS
- Practice address
- 706 Ave G
Marble Falls, TX 78654-5866 - Phone
- (830) 693-8234
- Fax
- (830) 693-9090
- NPI assigned
- Nov 12, 2010
- Organization subpart
- No
Authorized official
- Name
- Timothy Ols
- Title
- Ceo
- Phone
- (830) 201-8679
Owners & managing parties with NPI records 15
-
Angel Eduardo Caldera, M.D.
-
Mark Wayne English, M.D.
-
Aval NA Ree Sian Green, M.D.
-
Muralidhar Jatla, MD
-
Mark L. Montgomery, M.D.
-
Arundhati Rao, M.D.
Owned or controlled facilities with NPI records 5
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 6
Facilities with the same owner 36
Practitioners 44
-
Martha Lubars, RN,MSN,FNP
-
Brooke Ash Alexander, FNP-C
-
Ryan P Allen, DO
-
Meredith Rae Burkhart, APRN
-
Courtney Brewer Craft, NP-C
-
Clark W Craig, MD
-
Camey Katherine Crane, D.O.
-
Sangeetha Dayalan, M.D.
-
Mark D. Ellis, N.P.
-
John Phillip Frasure, PA-C
-
Sandra George, DO
-
Patricia Sue Hernandez, APRN
-
Carmen Abigail Hutson, DNP, APRN, FNP-C
-
Vineeth Reddy Lekkala, MBBS
-
Scott Liggett, MD
-
Grady F Miller, DO
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D0908131 | Baylor Scott & White Clinic - Marble Falls | Provider-performed microscopy | Mar 2, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Rural health clinic certification: CCN 458693
- Legal name
- SCOTT & WHITE HOSPITAL - MARBLE FALLS
- Doing business as
- BAYLOR SCOTT & WHITE CLINIC - MARBLE FALLS
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 19, 1996
- Last certification
- Aug 23, 2016
- Ownership / control type
- 2B
- Most recent change of ownership
- Sep 1, 2019 (4 total)
- Organization structure
- Other · Non-profit
- Incorporated
- Feb 11, 2013 in TX
- Enrollment address
- 706 Avenue G
Marble Falls, TX 78654-5866 - Related CCNs
- 450219
All disclosed owners & managing parties 24
| Name | Role | Since | Share |
|---|---|---|---|
| William Rogers |
Operational/Managerial Control |
Jul 1, 2015 | |
| Justin Meier |
Operational/Managerial Control |
Feb 9, 2023 | |
| Mark L Montgomery |
Operational/Managerial Control |
Nov 1, 2015 | |
| Morris E Foster |
Operational/Managerial Control |
Jul 1, 2015 | |
| Mark W English |
Operational/Managerial Control |
Jul 1, 2022 | |
| Tresa Muir McNeal |
Operational/Managerial Control |
Nov 30, 2017 | |
| Thomas Burdett |
Operational/Managerial Control |
Jul 1, 2015 | |
| Terry Maness |
Operational/Managerial Control |
May 11, 2020 | |
| Baylor Scott & White Health |
Operational/Managerial Control | Sep 1, 2019 | |
| Dominic Lucia |
Operational/Managerial Control |
Dec 4, 2020 | |
| William D Digaetano |
Operational/Managerial Control |
May 11, 2020 | |
| Muralidhar Jatla |
Operational/Managerial Control |
Jul 1, 2023 | |
| Timothy Ols |
Corporate Director |
Sep 1, 2019 | |
| W-2 Managing Employee |
Sep 1, 2019 | ||
| Operational/Managerial Control |
Sep 1, 2019 | ||
| Jim Kruse |
Operational/Managerial Control |
Jul 1, 2015 | |
| Nelda Trevino |
Operational/Managerial Control |
Dec 4, 2020 | |
| Jason Cole |
Corporate Director |
Mar 29, 2024 | |
| W-2 Managing Employee |
Mar 29, 2024 | ||
| Operational/Managerial Control |
Mar 29, 2024 | ||
| Scott & White Hospital - Marble Falls |
5% Or Greater Indirect Ownership Interest | Sep 1, 2019 | 100% |
| Aval-NA'Ree S Green |
Operational/Managerial Control |
Jul 1, 2023 | |
| Angel Eduardo Caldera |
Operational/Managerial Control |
Nov 30, 2017 | |
| Arundhati Rao |
Operational/Managerial Control |
Dec 4, 2020 | |
| Kristen Leslie Manos |
Corporate Director |
Jul 1, 2025 | |
| Andra Liemandt |
Operational/Managerial Control |
Jul 1, 2023 | |
| Jarvis Parsons |
Operational/Managerial Control |
Jul 1, 2024 | |
| Megan Kiella |
Corporate Director |
Jul 1, 2025 |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Baylor Scott & White Clinic - Horseshoe Bay |
Rural health clinic | 5% Or Greater Indirect Ownership Interest (100%) | Sep 1, 2019 |
| Baylor Scott & White Clinic - Kingsland |
Rural health clinic | 5% Or Greater Indirect Ownership Interest (100%) | Sep 1, 2019 |
| Baylor Scott & White Clinic - Johnson City |
Rural health clinic | 5% Or Greater Indirect Ownership Interest (100%) | Sep 1, 2019 |
| Baylor Scott & White Clinic - San Saba |
Rural health clinic | 5% Or Greater Indirect Ownership Interest (100%) | Sep 1, 2019 |
| Baylor Scott & White Clinic - Llano |
Rural health clinic | 5% Or Greater Indirect Ownership Interest (100%) | Sep 1, 2019 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Sep 1, 2019 | Change of Ownership |
Baylor Scott & White Medical Center-Llano |
| Sep 1, 2019 | Change of Ownership |
Baylor Scott & White Clinic - Marble Falls |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191028001507 | TX | Part a Provider - Rural Health Clinic | 6901117175 | Practice locations: Marble Falls, TX |
National Provider Directory
- Tax ID family
- Scott White Hospital - Marble Falls
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 100090 | TX | Yes |
Addresses
Primary practice location
706 Ave G
Marble Falls, TX 78654-5866
Mailing address
PO Box 844658
Dallas, TX 75284-4339
Phone (254) 724-2111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 283840102 | Other | TX | MEDICAID THSTEPS |
| 0042WF | Other | TX | BCBS |
| 283840103 | Medicaid | TX |
Other names
- BAYLOR SCOTT & WHITE CLINIC - MARBLE FALLS
Other providers in Marble Falls, TX
- Jenna Saxton
- Robert Schiener
- Carla Schnitz
- Michael Schwarz
- Scott & White Hospital - Marble Falls
- Scott & White Hospital - Marble Falls
- Simran Sedani
- Senior Health Northwood LLC
- Zainab Shahid
- Gary Edward Shanks
All providers in Marble Falls, TX · Rural Health Clinic/Center in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2019. 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.