NPIMap

Organization Active NPI

Parker County Hospital District

Doing business as College Park Rehabilitation and Care Center

  • Skilled Nursing Facility
  • Weatherford, TX
National Provider Identifier
1679721344
Registry record updated Dec 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PARKER COUNTY HOSPITAL DISTRICT
Doing business as
College Park Rehabilitation and Care Center
Practice address
1715 Martin Dr
Weatherford, TX 76086-6738
Phone
(817) 458-3100
Fax
(817) 458-3150
NPI assigned
Sep 5, 2008
Last updated
Dec 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2021

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

Authorized official

Name
Randy Bacus
Title
Ceo
Phone
(817) 341-2520

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X TX Primary

Addresses

Primary practice location

1715 Martin Dr
Weatherford, TX 76086-6738

Mailing address

1130 Pecan Dr
Weatherford, TX 76086-5774
Phone (817) 341-2520

Other identifiers 1

IdentifierTypeStateIssuer
103708OtherTXFACILITY ID

Other names 1

  • College Park Rehabilitation and Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150408000591 TX Part A Provider - Skilled Nursing Facility 0840269163 Practice locations: Weatherford, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679721344. Details of each certification follow.

Skilled nursing facility certification: CCN 676212

Legal name
PARKER COUNTY HOSPITAL DISTRICT
Doing business as
COLLEGE PARK REHABILITATION AND CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Feb 26, 2009
Last certification
Mar 27, 2025
Beds
120
Ownership / control type
Hospital District
Multi-facility organization
Priority Management Group
Most recent change of ownership
Jan 15, 2015
Organization structure
GovernmentNon-profit
Enrollment address
1715 Martin Dr
Weatherford, TX 76086-6738
Nursing home name
COLLEGE PARK REHABILITATION AND CARE CENTER
Affiliated entity
PRIORITY MANAGEMENT

Other NPIs with the same Medicare PAC ID 7

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
College Park Rehabilitation and Care CenterCCN 676212 · All quality measures
Overall star rating
4 of 5
Health inspections
5 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Government - Hospital district
Certified
Feb 26, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12089.8 residents per day on average
Chain
Priority Management38 facilities in the chain
Penalties (3 years)
1Fines totaling $38,675

Processed by Care Compare on Aug 1, 2026.

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
45D1095372College Park Rehabilitation & Care Center1715 Martin Drive, Weatherford, TX 76086Certificate of waiverFeb 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Campbell Hospital9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
PMG Opco - College Park LLC Organization, Dallas, TX LLC Operational/Managerial Control Jan 15, 2025
Adp of the SNF Feb 21, 2025
Douglas B Boulware Individual Adp of the SNF Jan 15, 2025
Katie B Walker Individual 5% Or Greater Mortgage Interest Jan 15, 2025 8.34%
Adp of the SNF Jan 15, 2025
Parker County Hospital District Organization, Weatherford, TX 5% Or Greater Direct Ownership Interest Jan 15, 2025 100%
Kris H Wusterhausen Individual Adp of the SNF Jan 15, 2025
PMG Realco - College Park LLC Organization, Dallas, TX LLC, Owned by another organization or individual 5% Or Greater Mortgage Interest Feb 28, 2025 100%
Adp of the SNF Feb 28, 2025
Thomas C Boulware Individual 5% Or Greater Mortgage Interest Jan 15, 2025 8.34%
Adp of the SNF Jan 15, 2025
Randy B Bacus Individual Corporate DirectorCeo May 1, 2017
Steven Boulware Family Investments LLC Organization, Dallas, TX LLC, Owned by another organization or individual 5% Or Greater Mortgage Interest Jan 15, 2025 33.34%
Adp of the SNF Jan 15, 2025
Bridgepointe Finanical Services, LLC Organization, Dallas, TX LLC Adp of the SNF Jan 15, 2025
Chad Wahrman Individual Operational/Managerial Control Aug 15, 2023
Adp of the SNF Aug 15, 2023
Priority Management Group, LLC Organization, Dallas, TX LLC Adp of the SNF Jan 15, 2025
Sandra Boulware Individual 5% Or Greater Mortgage Interest Jan 15, 2025 8.34%
Adp of the SNF Jan 15, 2025
Steven D Boulware Individual Operational/Managerial Control Jan 15, 2025
Adp of the SNF Jan 15, 2025
Parker C Bauder Individual 5% Or Greater Mortgage Interest Jan 15, 2025 8.34%
Adp of the SNF Jan 15, 2025
Boulware St James LLC Organization, Dallas, TX LLC, Owned by another organization or individual 5% Or Greater Mortgage Interest Jan 15, 2025 33.34%
Adp of the SNF Jan 15, 2025
Innovative Nurse Consulting, LLC Organization, Dallas, TX LLC Adp of the SNF Jan 15, 2025
Kelly P Bauder Individual 5% Or Greater Mortgage Interest Jan 15, 2025 8.34%
Adp of the SNF Jan 15, 2025
Progressive Rehab Solutions, LLC Organization, Dallas, TX LLC Adp of the SNF Jan 15, 2025
Madison R Bauder Individual 5% Or Greater Mortgage Interest Jan 15, 2025 8.34%
Adp of the SNF Jan 15, 2025
William M Bauder Individual Operational/Managerial Control Jan 15, 2025
Adp of the SNF Jan 15, 2025
Bauder Family Investments, LLC Organization, Dallas, TX LLC, Owned by another organization or individual 5% Or Greater Mortgage Interest Jan 15, 2025 33.33%
Adp of the SNF Jan 15, 2015

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hilltop Park Rehabilitation and Healthcare CenterWeatherford, TX, CCN 675988 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 15, 2015
Willow Park Rehabilitation and Healthcare CenterWillow Park, TX, CCN 676365 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2026
Matlock Place Health & Rehabilitation CenterArlington, TX, CCN 676141 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2014
Springtown Park Rehabilitation and Care CenterSpringtown, TX, CCN 676499 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2024
Campbell ClinicWeatherford, TX, CCN 673902 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 4, 1994

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Practitioners 10

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.

Affiliated clinicians 2

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": "1220572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640649600000",
    "number": "1679721344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 PECAN DR",
            "city": "WEATHERFORD",
            "state": "TX",
            "postal_code": "760865774",
            "telephone_number": "817-341-2520",
            "fax_number": "817-458-3150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 MARTIN DR",
            "city": "WEATHERFORD",
            "state": "TX",
            "postal_code": "760866738",
            "telephone_number": "817-458-3100",
            "fax_number": "817-458-3150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKER COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-05",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A",
        "authorized_official_last_name": "BACUS",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-341-2520"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY ID",
            "identifier": "103708",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "College Park Rehabilitation and Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "College Park Rehabilitation and Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Weatherford, TX

Sources for this page

Verify at the official NPI Registry.