NPIMap

Organization Active NPI

Adventhealth Family Medicine Rural Health Clinics, Inc.

  • Rural Health Clinic/Center
  • Lampasas, TX
National Provider Identifier
1639735335
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ADVENTHEALTH FAMILY MEDICINE RURAL HEALTH CLINICS, INC.
Practice address
187 PR 4060
Lampasas, TX 76550-4071
Phone
(512) 556-3621
Fax
(512) 556-6594
NPI assigned
May 17, 2019
Last updated
Jul 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Authorized official

Name
Kimberlee Gabara
Title
Dir Practice Operations
Phone
(512) 556-3621

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

187 PR 4060
Lampasas, TX 76550-4071

Mailing address

PO Box 6278
Fort Worth, TX 76115-0278
Phone (817) 568-4556

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191014002768 TX Part A Provider - Rural Health Clinic 8628308533 Practice locations: Lampasas, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639735335. Details of each certification follow.

Rural health clinic certification: CCN 458905

Legal name
ADVENTHEALTH FAMILY MEDICINE RURAL HEALTH CLINICS, INC
Doing business as
ADVENTHEALTH FAMILY MEDICINE CLINIC LAMPASAS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 13, 1995
Last certification
Jul 10, 2018
Ownership / control type
1B
Most recent change of ownership
Sep 1, 2019 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 2010 in FL
Enrollment address
187 Private Road 4060
Lampasas, TX 76550-4071

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
45D0488279Adventhealth Family Medicine Clinic Lampasas187 Private Road 4060,Ste 200, Lampasas, TX 76550Provider-performed microscopySep 16, 2026
45D0901056Adventhealth Family Medicine Rural Health187 Private Road 4060, Lampasas, TX 76550Provider-performed microscopySep 14, 2026

National Provider Directory

National Provider Directory
Tax ID family
Adventhealth Fam Med - Copperas Cove2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Member of 2

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

Locations

187 Private Road 4060
Lampasas, TX 76550
Phone (512) 556-3621

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Mark Steven Lane Individual Corporate Director Sep 1, 2019
W-2 Managing EmployeeMedical Director Sep 1, 2019
James E Cain Individual Corporate DirectorBoard Member Sep 1, 2019
W-2 Managing EmployeeMedical Director Sep 1, 2019
Kimberlee Cabara Individual Corporate DirectorPractice Administrator Sep 1, 2019
W-2 Managing EmployeePractice Administrator Sep 1, 2019
Kelly Jasinski Individual Corporate DirectorAssistant Vice President/Physici Sep 1, 2019
W-2 Managing EmployeeAssistant Vice President/Physici Sep 1, 2019
Kevin Roberts Individual Corporate OfficerPresident and Ceo Sep 1, 2019
Metroplex Adventist Hospital, Inc. Organization, Killeen, TX Corporation, Non-profit 5% Or Greater Direct Ownership Interest Aug 9, 2019 100%
Adventist Health System Sunbelt Healthcare Corporation Organization, Altamonte Springs, FL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 17, 1981 68%
Parker J Pridgen Individual Corporate OfficerCoo/Cfo Sep 1, 2019
Scott & White Memorial Hospital Organization, Temple, TX Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2008 32%

Owners & managing parties with NPI records 11

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

Facilities with the same owner 86

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

View all 86

Change-of-ownership history 1

DateEventCounterparty
Sep 1, 2019 Change of OwnershipThis provider was the buyer Family Medicine Rural Health Clinic, PACCN 458905, TX, NPI 1699731257

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 11

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": "1558051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1639735335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6278",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761150278",
            "telephone_number": "817-568-4556",
            "fax_number": "817-568-5474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "187 PR 4060",
            "city": "LAMPASAS",
            "state": "TX",
            "postal_code": "765504071",
            "telephone_number": "512-556-3621",
            "fax_number": "512-556-6594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTHEALTH FAMILY MEDICINE RURAL HEALTH CLINICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-17",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A",
        "authorized_official_last_name": "GABARA",
        "authorized_official_first_name": "KIMBERLEE",
        "authorized_official_title_or_position": "DIR PRACTICE OPERATIONS",
        "authorized_official_telephone_number": "512-556-3621"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lampasas, TX

Sources for this page

Verify at the official NPI Registry.