NPIMap

Organization Active NPI

Christus Health Ark-la-Tex

Doing business as CHRISTUS St Michael Rehabilitation Hospital

  • Rehabilitation Hospital Unit
  • Texarkana, TX
National Provider Identifier
1467453902
Registry record updated Jul 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
Legal business name
CHRISTUS HEALTH ARK-LA-TEX
Doing business as
CHRISTUS St Michael Rehabilitation Hospital
Practice address
2400 Saint Michael Dr
Texarkana, TX 75503-2374
Phone
(903) 614-4000
Fax
(903) 614-8463
NPI assigned
Aug 9, 2005
Last updated
Jul 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2022

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

Authorized official

Name
Jason Matthew Adams
Title
President
Phone
(903) 614-2001

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X NU Primary
Rehabilitation Hospital 283X00000X 000713 TX

Addresses

Primary practice location

2400 Saint Michael Dr
Texarkana, TX 75503-2374

Mailing address

2400 Saint Michael Dr
Texarkana, TX 75503-2374
Phone (903) 614-4000

Other identifiers 7

IdentifierTypeStateIssuer
094353202MedicaidTX
100703010AMedicaidOK
10522OtherARBLUE CROSS
HH0896OtherTXBLUE CROSS
34337OtherLABLUE CROSS
146092126MedicaidAR
75504-0000OtherCHAMPUS

Other names 1

  • CHRISTUS St Michael Rehabilitation Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220804000175 TX Part A Provider - Hospital 2264325588 Practice locations: Texarkana, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467453902. Details of each certification follow.

Hospital certification: CCN 45T801

Legal name
CHRISTUS HEALTH ARK-LA-TEX
Doing business as
CHRISTUS ST MICHAEL REHABILITATION HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Jan 4, 1999 in TX
Enrollment address
2400 Saint Michael Dr
Texarkana, TX 75503-2374
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

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).

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Christus St Michael Health SystemCCN 45T801 · All quality measures
Ownership
Non-profit
Certified
Jul 1, 2022

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

401 East St
Texarkana, AR 71854
Phone (870) 216-0829

901 S William St
Atlanta, TX 75551
Phone (903) 799-3262

210 N Kenwood Rd
Texarkana, TX 75501
Phone (903) 336-3134

2500 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-2975

2602 Saint Michael Dr
Ste 201C
Texarkana, TX 75503
Phone (903) 614-2073

2602 Saint Michael Dr
Ste 202
Texarkana, TX 75503
Phone (903) 614-5260

2602 Saint Michael Dr
Ste 249
Texarkana, TX 75503
Phone (903) 614-7699

2602 Saint Michael Dr
Ste 302A
Texarkana, TX 75503
Phone (903) 614-5016

2602 Saint Michael Dr
Ste 302C
Texarkana, TX 75503
Phone (903) 614-2956

2602 Saint Michael Dr
Ste 402
Texarkana, TX 75503
Phone (903) 614-4276

2604 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-2650

2604 Saint Michael Dr
Ste 237
Texarkana, TX 75503
Phone (903) 614-5180

2604 Saint Michael Dr
Ste 240
Texarkana, TX 75503
Phone (903) 614-5601

2604 Saint Michael Dr
Ste 345
Texarkana, TX 75503
Phone (903) 838-5500

2604 Saint Michael Dr
Ste 435
Texarkana, TX 75503
Phone (903) 614-4177

5002 Cowhorn Creek Rd
Ste 1156
Texarkana, TX 75503
Phone (903) 614-5470

5002 Cowhorn Creek Rd
Ste 3205
Texarkana, TX 75503
Phone (903) 614-8500

5002 Cowhorn Creek Rd
Ste 5033
Texarkana, TX 75503
Phone (903) 614-5005

5522 Summerhill Rd
Texarkana, TX 75503
Phone (903) 614-4276

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Jason Adams Individual Corporate OfficerPresident Feb 15, 2021
Corporate DirectorBoard Member Feb 15, 2021
John Christopher Glenney Individual Corporate DirectorBoard Member Jan 1, 2021
Christus Health Organization, Irving, TX Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Jan 1, 2021 100%
Christus Northeast Texas and Northern Louisiana Health System Corp Organization, Irving, TX Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2021 100%
Shannon Dacus Individual Corporate DirectorBoard Member Jan 1, 2021
Rita Fanning Individual Corporate DirectorBoard Member Jan 21, 2021
Theresa M Popp Individual Corporate DirectorBoard Member Jan 1, 2022
Jeb Jones Individual Corporate DirectorBoard Member Jan 21, 2021
Michael G Boles Individual Corporate OfficerCfo Feb 26, 2012
W-2 Managing EmployeeCfo Feb 26, 2012
Mark R Anderson Individual Corporate DirectorBoard Member Jan 1, 2021
Sonia Acosta Individual Corporate DirectorBoard Member Sep 16, 2024
Steven P Keuer Individual Corporate DirectorBoard Member Jan 1, 2021

Owners & managing parties with NPI records 3

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

Facilities with the same owner 49

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

View all 49

Practitioners & affiliated clinicians

Practitioners 115

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 115

Affiliated clinicians 7

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": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657324800000",
    "number": "1467453902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 SAINT MICHAEL DR",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032374",
            "telephone_number": "903-614-4000",
            "fax_number": "903-614-8463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 SAINT MICHAEL DR",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032374",
            "telephone_number": "903-614-4000",
            "fax_number": "903-614-8463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTUS HEALTH ARK-LA-TEX",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2022-07-09",
        "certification_date": "2022-07-09",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-614-2001"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": "TX",
            "license": "000713",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "094353202",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100703010A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "10522",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "HH0896",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "34337",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146092126",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "75504-0000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHRISTUS St Michael Rehabilitation Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHRISTUS St Michael Rehabilitation Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Texarkana, TX

Sources for this page

Verify at the official NPI Registry.