NPIMap

Organization Active NPI

Ebd Bemc Burleson, LLC

Doing business as Baylor Scott & White Emergency Hospital Burleson

  • General Acute Care Hospital
  • Burleson, TX
National Provider Identifier
1679903967
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
EBD BEMC BURLESON, LLC
Doing business as
Baylor Scott & White Emergency Hospital Burleson
Practice address
12500 South Fwy
Suite 100
Burleson, TX 76028-7004
Phone
(214) 294-6250
Fax
(713) 637-1305
NPI assigned
Nov 22, 2013
Last updated
May 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Authorized official

Name
Mrs. Tina Johnson
Title
Sr Med Staff & Provider Enrollment
Phone
(713) 637-1146

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU
General Acute Care Hospital 282N00000X NU Primary

Addresses

Primary practice location

12500 South Fwy
Suite 100
Burleson, TX 76028-7004

Mailing address

8686 New Trails Dr
Suite 100
The Woodlands, TX 77381-1176
Phone (716) 637-1144

Other identifiers 2

IdentifierTypeStateIssuer
348928801MedicaidTX
348928802MedicaidTX

Other names 1

  • Baylor Scott & White Emergency Hospital Burleson Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140714000550 TX Part A Provider - Hospital 5193940849 2 other NPIs on this enrollment
Practice locations: Burleson, TX; Grand Prairie, TX; Mansfield, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679903967. Details of each certification follow.

Hospital certification: CCN 670107

Legal name
EBD BEMC BURLESON, LLC
Doing business as
BAYLOR SCOTT & WHITE EMERGENCY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Mar 19, 2015
Last certification
Mar 19, 2015
Beds
16
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
May 9, 2014 in TX
Enrollment address
12500 South Fwy
Ste 100
Burleson, TX 76028-7128
Other Hospital Practice Location
Hospital subgroups
Acute care

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Baylor Scott and White Emergency HospitalCCN 670107 · All quality measures
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Ebd Bemc Burleson LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Member of 1

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

Locations

12500 South Fwy
Ste 100
Burleson, TX 76028
Phone (214) 294-6250

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Vanessa Smith Individual Corporate OfficerPresident Nov 9, 2022
W-2 Managing Employee Nov 9, 2022
Emerus Group Holdings LP Organization, New York, NY Holding company 5% Or Greater Indirect Ownership Interest Sep 1, 2015 49%
Ebd JV, LLP Organization, The Woodlands, TX For-profit 5% Or Greater Indirect Ownership Interest Nov 14, 2013 49%
Victor Schmerbeck Individual W-2 Managing Employee Feb 15, 2020
John E Buck Individual 5% Or Greater Indirect Ownership Interest Nov 14, 2013 5.58%
Emerus Intermediate Holdings Inc Organization, New York, NY Corporation, Holding company 5% Or Greater Indirect Ownership Interest Sep 1, 2015 49%
Toby R Hamilton Individual 5% Or Greater Indirect Ownership Interest Nov 14, 2013 5.58%
Jaba Interest LLC Organization, The Woodlands, TX LLC 5% Or Greater Indirect Ownership Interest Oct 16, 2014 5.17%
Thanh Tran Individual Corporate OfficerSecretary Nov 9, 2022
W-2 Managing Employee Nov 9, 2022
Emerus Holdings, Inc. Organization, The Woodlands, TX For-profit 5% Or Greater Indirect Ownership Interest Nov 14, 2013 49%
Welsh Carson Anderson & Stowe XII, LP Organization, New York, NY 5% Or Greater Indirect Ownership Interest Sep 1, 2015 19.37%
Baylor University Medical Center Organization, Dallas, TX 5% Or Greater Indirect Ownership Interest Nov 14, 2013 51%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 17

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

View all 17

Practitioners & affiliated clinicians

Affiliated clinicians 46

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

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1385078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1679903967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8686 NEW TRAILS DR",
            "address_2": "SUITE 100",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773811176",
            "telephone_number": "716-637-1144",
            "fax_number": "281-292-3585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12500 SOUTH FWY",
            "address_2": "SUITE 100",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760287004",
            "telephone_number": "214-294-6250",
            "fax_number": "713-637-1305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBD BEMC BURLESON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-22",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "SR MED STAFF & PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "713-637-1146",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "348928801",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "348928802",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baylor Scott & White Emergency Hospital Burleson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Burleson, TX

Sources for this page

Verify at the official NPI Registry.