NPIMap

Organization Active NPI

Bellville Medical Center

Doing business as Mid Coast Medical Center-Bellville

  • General Acute Care Hospital
  • Bellville, TX
National Provider Identifier
1477857332
Registry record updated Mar 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
100210 Issued in TX
Legal business name
BELLVILLE MEDICAL CENTER
Doing business as
Mid Coast Medical Center-Bellville
Mid Coast Medical Clinic-Bellville
Practice address
44 N. Cummings St.
Bellville, TX 77418
Phone
(979) 413-7400
Fax
(979) 413-7190
NPI assigned
Jan 6, 2011
Last updated
Mar 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2023

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

Authorized official

Name
Mr. David Mak
Title
Chief Financial Officer
Phone
(979) 543-6251

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 00552 TX
General Acute Care Hospital 282N00000X 100210 TX Primary
Family Medicine Physician 207Q00000X
Surgery Physician 208600000X
Colon & Rectal Surgery Physician 208C00000X

Addresses

Primary practice location

44 N. Cummings St.
Bellville, TX 77418

Mailing address

PO Box 977
Bellville, TX 77418
Phone (979) 413-7400

Other practice location 1

235 W Palm St Ste 105
Bellville, TX 77418-1300
Phone (979) 865-3124

Other identifiers 6

IdentifierTypeStateIssuer
0832909-05MedicaidTX
083290905MedicaidTX
45U253OtherSWING BED
0832909-06MedicaidTX
0832909-04MedicaidTX
45U253OtherTXSWING BED

Other names 2

  • Mid Coast Medical Center-Bellville Doing business as
  • Mid Coast Medical Clinic-Bellville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20110317000679 TX Part A Provider - Hospital 9830379031 Practice locations: Bellville, TX
O20110317000853 TX Part A Provider - Hospital 9830379031 Practice locations: Bellville, TX
O20190911001133 TX Part B Supplier - Clinic/Group Practice 9830379031 Receives reassigned benefits from 4 practitioners
Practice locations: Bellville, TX

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1477857332. Details of each certification follow.

Hospital certification: CCN 450253

Legal name
BELLVILLE MEDICAL CENTER
Doing business as
MID COAST MEDICAL CENTER-BELLVILLE
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jan 1, 1976
Last certification
Jun 8, 2018
Beds
32
Ownership / control type
Hospital district or authority
Most recent change of ownership
Jan 1, 2011 (2 total)
Organization structure
OtherNon-profit
Incorporated
Nov 18, 2010 in TX
Enrollment address
44 N Cummings St
Bellville, TX 77418-1347
Main/Primary Hospital Location
Hospital subgroups
Acute care

Hospital certification: CCN 45U253

Legal name
BELLVILLE MEDICAL CENTER
Doing business as
MID COAST MEDICAL CENTER-BELLVILLE
Organization structure
OtherNon-profit
Incorporated
Nov 18, 2010 in TX
Enrollment address
44 N Cummings St
Bellville, TX 77418-1347
Hospital Swing-Bed Unit
Hospital subgroups
General, Swing-bed approved

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

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Bellville Medical CenterCCN 450253 · All quality measures
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

235 W Palm St
Ste 10
Bellville, TX 77418
Phone (979) 413-4340

235 W Palm St
Ste 105
Bellville, TX 77418
Phone (409) 861-0100

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
David Mak Individual Corporate DirectorChief Financial Officer Jan 1, 2024
W-2 Managing EmployeeChief Financial Officer Jan 1, 2024
Corporate DirectorChief Financial Officer Mar 17, 2022
W-2 Managing EmployeeChief Financial Officer Mar 17, 2022
Operational/Managerial ControlChief Financial Officer Mar 17, 2022
Lisa Altenhoff Individual Corporate DirectorBusiness Office Director Jan 1, 2024
W-2 Managing EmployeeBusiness Office Director Jan 1, 2024
Brett Kirkham Individual Corporate DirectorChief Executive Officer Nov 1, 2023
W-2 Managing EmployeeChief Executive Officer Nov 1, 2023
Corporate DirectorChief Executive Officer Oct 1, 2023
Operational/Managerial ControlChief Executive Officer Oct 1, 2023
Mid Coast Health System Organization, El Campo, TX Corporation, For-profit Operational/Managerial Control Jan 1, 2024
Bellville Medical Center Organization, Bellville, TX Operational/Managerial Control Jan 1, 2011

Owners & managing parties with NPI records 2

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

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 71

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 71

Affiliated clinicians 64

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

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1294272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679875200000",
    "number": "1477857332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 977",
            "city": "BELLVILLE",
            "state": "TX",
            "postal_code": "77418",
            "telephone_number": "979-413-7400",
            "fax_number": "979-413-7190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 N. CUMMINGS ST.",
            "city": "BELLVILLE",
            "state": "TX",
            "postal_code": "77418",
            "telephone_number": "979-413-7400",
            "fax_number": "979-413-7190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "235 W Palm St Ste 105",
            "address_purpose": "LOCATION",
            "city": "Bellville",
            "state": "TX",
            "postal_code": "774181300",
            "country_code": "US",
            "telephone_number": "979-865-3124",
            "fax_number": "979-865-9193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BELLVILLE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-06",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A",
        "authorized_official_last_name": "MAK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "979-543-6251",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TX",
            "license": "00552",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TX",
            "license": "100210",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0832909-05",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "083290905",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SWING BED",
            "identifier": "45U253",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0832909-06",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0832909-04",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SWING BED",
            "identifier": "45U253",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid Coast Medical Center-Bellville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mid Coast Medical Clinic-Bellville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mid Coast Medical Clinic-Bellville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellville, TX

Sources for this page

Verify at the official NPI Registry.