NPIMap

Organization Active NPI

Preferred Hospital Leasing Inc

Doing business as Collingsworth Family Medicine

  • Rural Health Clinic/Center
  • Wellington, TX
National Provider Identifier
1407893316
Registry record updated Jun 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PREFERRED HOSPITAL LEASING INC
Doing business as
Collingsworth Family Medicine
Practice address
1011 15TH St
Wellington, TX 79095-3704
Phone
(806) 447-5311
Fax
(806) 447-3090
NPI assigned
May 31, 2006
Last updated
Jun 24, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2019

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

Authorized official

Name
Mr. Donald Freeman
Title
Vice President
Phone
(405) 878-0202

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Emergency Medicine Physician 207P00000X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU

Addresses

Primary practice location

1011 15TH St
Wellington, TX 79095-3704

Mailing address

1011 15TH St
Wellington, TX 79095-3704
Phone (806) 447-5311

Other identifiers 3

IdentifierTypeStateIssuer
126840108MedicaidTX
126840106MedicaidTX
179285501MedicaidTX

Other names 1

  • Collingsworth Family Medicine Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040614000353 TX Part A Provider - Rural Health Clinic 4284617077 Practice locations: Wellington, TX
O20050209000406 TX Part B Supplier - Clinic/Group Practice 4284617077 Receives reassigned benefits from 10 practitioners
Practice locations: Wellington, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407893316. Details of each certification follow.

Rural health clinic certification: CCN 458842

Legal name
PREFERRED HOSPITAL LEASING INC
Doing business as
COLLINGSWORTH FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 1, 2004
Last certification
Jan 9, 2018
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jan 8, 2004 in OK
Enrollment address
1011 15TH St
Collingsworth Family Medicine
Wellington, TX 79095-3704
Related CCNs
451355

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

Other NPIs with the same Medicare PAC ID 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1023381Preferred Hospital Leasing,Inc1011 15TH Street, Wellington, TX 79095Certificate of waiverMar 15, 2028

National Provider Directory

National Provider Directory

Locations

1011 15th St
Wellington, TX 79095
Phone (806) 447-5311

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Donald a Freeman Individual 5% Or Greater Direct Ownership Interest Apr 1, 2004 100%
Corporate OfficerPresident Apr 1, 2004 100%
Candy Powell Individual W-2 Managing Employee Oct 1, 2007
Preferred Management Corporation Organization, Shawnee, OK For-profit Operational/Managerial Control Apr 1, 2004
Kathleen Mechler Individual Corporate OfficerDirector of Clinical Services Jul 1, 2023
Karla a Betterton Individual Corporate OfficerVP of Finance Apr 1, 2004
Jared Chanski Individual Corporate OfficerExecutive Vice President Jan 1, 2019
Josh Tucker Individual Corporate OfficerChief Financial Officer Dec 1, 2017

Facilities with the same owner 35

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

View all 35

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561334400000",
    "number": "1407893316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 15TH ST",
            "city": "WELLINGTON",
            "state": "TX",
            "postal_code": "790953704",
            "telephone_number": "806-447-5311",
            "fax_number": "806-447-3090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 15TH ST",
            "city": "WELLINGTON",
            "state": "TX",
            "postal_code": "790953704",
            "telephone_number": "806-447-5311",
            "fax_number": "806-447-3090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREFERRED HOSPITAL LEASING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2019-06-24",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "405-878-0202",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126840108",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126840106",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179285501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collingsworth Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Collingsworth Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wellington, TX

Sources for this page

Verify at the official NPI Registry.