NPIMap

Organization Active NPI

Refugio County Memorial Hospital District

Doing business as Woodsboro Medical Clinic

  • Rural Health Clinic/Center
  • Woodsboro, TX
National Provider Identifier
1467495184
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
REFUGIO COUNTY MEMORIAL HOSPITAL DISTRICT
Doing business as
Woodsboro Medical Clinic
Practice address
120 Wood Ave
Woodsboro, TX 78393-0897
Phone
(361) 543-5414
NPI assigned
Jun 13, 2006
Last updated
Jun 12, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
REFUGIO COUNTY MEMORIAL HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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

Authorized official

Name
Mr. Corey Wasicek
Title
Ceo
Phone
(361) 526-2321

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Critical Access Hospital Clinic/Center 261QC0050X TX
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

120 Wood Ave
Woodsboro, TX 78393-0897

Mailing address

PO Box 897
120 Wood Ave
Woodsboro, TX 78393-0897
Phone (361) 543-5414

Other identifiers 2

IdentifierTypeStateIssuer
0925273-02MedicaidTX
0925273-01MedicaidTX

Other names 1

  • Woodsboro Medical Clinic Doing business as

Electronic endpoints 5

TypeEndpointUseAffiliation
Direct Messaging Address jwineman@rcmh.cernerdirect.com Direct
Direct Messaging Address rmac@rcmh.cernerdirect.com Direct
Direct Messaging Address kstaples@rcmh.cernerdirect.com Direct
Direct Messaging Address dmcmahan@rcmh.cernerdirect.com Direct
Direct Messaging Address pscherrer@rcmh.cernerdirect.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100608000078 TX Part A Provider - Rural Health Clinic 1153216783 Practice locations: Woodsboro, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467495184. Details of each certification follow.

Rural health clinic certification: CCN 673982

Legal name
REFUGIO COUNTY MEMORIAL HOSPITAL DISTRICT
Doing business as
WOODSBORO MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 14, 1992
Last certification
Jul 18, 2017
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
120 Wood Ave
Woodsboro, TX 78393-3517
Related CCNs
451317

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

Other NPIs with the same Medicare PAC ID 5

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
45D0696469Woodsboro Medical Clinic120 Wood Avenue, Woodsboro, TX 78393Provider-performed microscopyMar 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
Refugio Mem Hosp Dis Em7 organizations share this tax ID, including this one
Part of
Refugio Mem Hosp Dis Em

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Corey a Wasicek Individual W-2 Managing EmployeeCeo Nov 5, 2021
Operational/Managerial ControlCeo Nov 5, 2021 100%
Refugio County Memorial Hospital District Organization, Woodsboro, TX 5% Or Greater Direct Ownership Interest Nov 5, 2021 100%

Owners & managing parties with NPI records 5

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
Refugio County Memorial Hospital DistrictRefugio, TX, CCN 451317 Hospital Operational/Managerial Control (100%) Aug 1, 1999
Refugio County Memorial Hospital DistrictRefugio, TX, CCN 45Z317 Hospital Operational/Managerial Control (100%) Nov 5, 2021

Owned or controlled facilities with NPI records 2

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 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1467495184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 897",
            "address_2": "120 WOOD AVE",
            "city": "WOODSBORO",
            "state": "TX",
            "postal_code": "783930897",
            "telephone_number": "361-543-5414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 WOOD AVE",
            "city": "WOODSBORO",
            "state": "TX",
            "postal_code": "783930897",
            "telephone_number": "361-543-5414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REFUGIO COUNTY MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REFUGIO COUNTY MEMORIAL HOSPITAL DISTRICT",
        "enumeration_date": "2006-06-13",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "WASICEK",
        "authorized_official_first_name": "COREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "361-526-2321",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0925273-02",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0925273-01",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwineman@rcmh.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Woodsboro Medical Clinic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "120 Wood Ave",
            "city": "Woodsboro",
            "state": "TX",
            "country_code": "US",
            "postal_code": "783930897",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rmac@rcmh.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Woodsboro Medical Clinic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "120 Wood Ave",
            "city": "Woodsboro",
            "state": "TX",
            "country_code": "US",
            "postal_code": "783930897",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kstaples@rcmh.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Woodsboro Medical Clinic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "120 Wood Ave",
            "city": "Woodsboro",
            "state": "TX",
            "country_code": "US",
            "postal_code": "783930897",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmcmahan@rcmh.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Woodsboro Medical Clinic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "120 Wood Ave",
            "city": "Woodsboro",
            "state": "TX",
            "country_code": "US",
            "postal_code": "783930897",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pscherrer@rcmh.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Woodsboro Medical Clinic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "120 Wood Ave",
            "city": "Woodsboro",
            "state": "TX",
            "country_code": "US",
            "postal_code": "783930897",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Woodsboro Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Woodsboro Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodsboro, TX

Sources for this page

Verify at the official NPI Registry.