Ethicus Hospital DFW LLC

Primary specialty

Long Term Care HospitalTaxonomy code 282E00000X

License

008742 Issued in TX

Legal business name

ETHICUS HOSPITAL DFW LLC

Doing business as

Sagecrest Hospital Grapevine

Practice address

4201 William D Tate Ave
Grapevine, TX 76051-5736

Phone

(817) 288-1300

Fax

(817) 288-1499

NPI assigned

Jul 25, 2008

Last updated

Oct 22, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

ETHICUS HOSPITAL GRAPEVINE LPAs reported in NPPES

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

Authorized official

Name

Mr. Jordan Fowler

Title

Ceo

Phone

(817) 288-1300

Specialties & licenses 1

Addresses

Other names 1

• Sagecrest Hospital Grapevine Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1659536944. Details of each certification follow.

• CCN 670265 Hospital · Active · Details
• CCN 452110 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 670265

Legal name

ETHICUS HOSPITAL DFW LLC

Doing business as

LEGENT ORTHOPEDIC HOSPITAL CARROLLTON

Certification status

Active

Provider type (POS)

Hospital – Short-term

Participating since

Jul 1, 2020

Last certification

Jan 23, 2026

Beds

60

Ownership / control type

Private (for profit)

Organization structure

LLCProprietary

Incorporated

Jul 21, 2008 in TX

Enrollment address

1401 E Trinity Mills Rd
Carrollton, TX 75006-1442
Main/Primary Hospital Location

Hospital subgroups

Acute care, Rehabilitation unit

Hospital certification: CCN 452110

Legal name

SAGECREST HOSPITAL GRAPEVINE

Certification status

Terminated Other: provider status change, Jun 30, 2020

Provider type (POS)

Hospital – Long-term

Participating since

Sep 1, 2008

Last certification

Sep 17, 2014

Beds

60

Ownership / control type

Private (for profit)

Facility address

4201 William D Tate Avenue
Grapevine, TX 76051

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Ethicus Hospital DFW LLC

  dba Legent Orthopedic Hospital

  • General Acute Care Hospital
  • Carrollton, TX
  • NPI 1316505043

  O20200805001731

  Same enrollment
• Ethicus Hospital DFW, LLC

  • Rehabilitation Hospital Unit
  • Carrollton, TX
  • NPI 1356133615

  O20200805001731

  Same enrollment

Listed as

Legent Orthopedic HospitalCCN 670265 · All quality measures

Type

Acute Care Hospitals

Ownership

Proprietary

Medicare certification status

ActiveFrom the Provider of Services file

Emergency services

Yes

Part of

Ethicus Hospital-Grapevine LP

Locations

All disclosed owners & managing parties 36

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

Owners & managing parties with NPI records 5

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

• Vudhi V Slabisak, MD

  • Orthopaedic Surgery of the Spine Physician
  • Plano, TX
  • NPI 1639109358

  5% Or Greater Direct Ownership Interest, 5% Or Greater Indirect Ownership Interest

  CMS ownership
• Mark K. Bowen, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Chicago, IL
  • NPI 1568419463

  Corporate Director

  CMS ownership
• Bryan T Kelly, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • New York, NY
  • NPI 1457386211

  Corporate Director, Corporate Officer

  CMS ownership
• New York Society for the Relief of Ruptured & Crippled Maintaining

  dba HSS Prosthetics & Orthotics

  • Prosthetic/Orthotic Supplier
  • New York, NY
  • NPI 1346835675

  Operational/Managerial Control

  CMS ownership
• New York Society for the Relief of Ruptured & Crippled Maintaining

  dba Hospital for Special Surgery

  • General Acute Care Hospital
  • New York, NY
  • NPI 1598703019

  Operational/Managerial Control

  CMS ownership

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Ethicus Hospital-Grapevine, LP

  • General Acute Care Hospital
  • Grapevine, TX
  • NPI 1699976852
  NPPES parent name

Affiliated clinicians 106

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

• Amre Aboul-Fettouh, DO

  • Pain Medicine (Anesthesiology) Physician
  • Garland, TX
  • NPI 1144883067

  Hospital

  Care Compare affiliation
• Asad Ahmad, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Houston, TX
  • NPI 1902145782

  Hospital

  Care Compare affiliation
• Salman Ahmad, M.D

  • Anesthesiology Physician
  • Flower Mound, TX
  • NPI 1871688952

  Hospital

  Care Compare affiliation
• Mohammed A Alhezayen, MD

  • Internal Medicine Physician
  • Plano, TX
  • NPI 1780635599

  Hospital

  Care Compare affiliation
• Bahar Anbar, PA

  • Surgical Physician Assistant
  • Dallas, TX
  • NPI 1548310691

  Hospital

  Care Compare affiliation
• Saeid Esmaeily Aryan, D.O

  • Neurological Surgery Physician
  • Fort Worth, TX
  • NPI 1144487174

  Hospital

  Care Compare affiliation
• Macarthur L Baker, M.D.

  • Anesthesiology Physician
  • Dallas, TX
  • NPI 1134442684

  Hospital

  Care Compare affiliation
• Salma Estrellita Balbuena, PA

  • Surgical Physician Assistant
  • Rowlett, TX
  • NPI 1346971611

  Hospital

  Care Compare affiliation
• Cynthia May Banigan, PA-C

  • Physician Assistant
  • Frisco, TX
  • NPI 1285388108

  Hospital

  Care Compare affiliation
• John Wesley Barrington, MD

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Plano, TX
  • NPI 1336120328

  Hospital

  Care Compare affiliation
• Jean Louis Benae, M.D

  • Neurological Surgery Physician
  • McKinney, TX
  • NPI 1922157486

  Hospital

  Care Compare affiliation
• Grant A. Booher, M.D.

  • Neurological Surgery Physician
  • Fort Worth, TX
  • NPI 1982963591

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1216944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571702400000",
    "number": "1659536944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 WILLIAM D TATE AVE",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760515736",
            "telephone_number": "817-288-1300",
            "fax_number": "817-288-1499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 WILLIAM D TATE AVE",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760515736",
            "telephone_number": "817-288-1300",
            "fax_number": "817-288-1499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHICUS HOSPITAL DFW LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ETHICUS HOSPITAL GRAPEVINE LP",
        "enumeration_date": "2008-07-25",
        "last_updated": "2019-10-22",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-288-1300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "TX",
            "license": "008742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sagecrest Hospital Grapevine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michelle Erving
• Cecilia Esparza
• Naznin Esphani, MD
• Noelle Estante, FNP-C
• Kaye E. Estell, L.P.C.
• Ethicus Hospital-Grapevine, LP
• Esmeralda B Evans-Rios
• Ami Evans, LPC
• Helen Elaine Ewing, MPAS, PA-C
• Examnet, LLC

• Long Term Care Hospital in Grapevine, TX
• Providers in Grapevine, TX by specialty
• Long Term Care Hospital in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.