Etmc Physician Group Inc.

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

ETMC PHYSICIAN GROUP INC.

Practice address

100 Municipal Dr Ste 300
Gun Barrel City, TX 75156-3703

Phone

(903) 713-1574

NPI assigned

Jun 7, 2021

Last updated

Jun 7, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stephen C. Petrovich

Title

Evp, General Counsel

Phone

(615) 296-3594

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689241945. Details of each certification follow.

• CCN 673967 Rural health clinic · Active · Details

Rural health clinic certification: CCN 673967

Legal name

ETMC PHYSICIAN GROUP, INC.

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Mar 8, 2022

Last certification

Mar 8, 2022

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Nov 19, 2017 in TX

Enrollment address

100 Municipal Dr
Ste 300
Gun Barrel City, TX 75156-3703

Other NPIs with the same Medicare PAC ID 2

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

• Etmc Physician Group Inc.

  • Rural Health Clinic/Center
  • Chandler, TX
  • NPI 1235706581

  4486915600

  Same PAC ID
• Etmc Physician Group Inc.

  • Cardiovascular Disease Physician
  • Tyler, TX
  • NPI 1609382662

  4486915600

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Etmc Physician Group Inc5 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.

• Etmc Physician Group Inc.

  • Rural Health Clinic/Center
  • Flint, TX
  • NPI 1093382368
  NPD tax ID
• Etmc Physician Group Inc.

  • Rural Health Clinic/Center
  • Bullard, TX
  • NPI 1154998433
  NPD tax ID
• Etmc Physician Group Inc.

  • Rural Health Clinic/Center
  • Chandler, TX
  • NPI 1235706581
  NPD tax ID
• Etmc Physician Group Inc.

  • Rural Health Clinic/Center
  • Lindale, TX
  • NPI 1598332868
  NPD tax ID

Locations

All disclosed owners & managing parties 11

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

All facility ownership & control disclosures 5

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

Owned or controlled facilities with NPI records 1

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

• Ut East Texas Urgent Care Centers, PLLC

  • Urgent Care Clinic/Center
  • Canton, TX
  • NPI 1356974281

  5% Or Greater Direct Ownership Interest

  CMS ownership

Facilities with the same owner 66

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

• Athens Hospital, LLC

  • General Acute Care Hospital
  • Athens, TX
  • NPI 1417465824

  Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

  CMS ownership
• Bsa Hospital LLC

  • General Acute Care Hospital
  • Amarillo, TX
  • NPI 1407191984

  Ahp Health Partners, Inc, Ahs Management Company Inc., Ardent Health Inc, Ardent Legacy Holdings LLC

  CMS ownership
• Bsa Hospital LLC

  • Rehabilitation Hospital Unit
  • Amarillo, TX
  • NPI 1730425190

  Ahp Health Partners, Inc, Ahs Management Company Inc., Ardent Health Inc, Ardent Legacy Holdings LLC

  CMS ownership
• Carthage Hospital, LLC

  • Rural Health Clinic/Center
  • Carthage, TX
  • NPI 1407355860

  Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

  CMS ownership
• Carthage Hospital, LLC

  • General Acute Care Hospital
  • Carthage, TX
  • NPI 1538667035

  Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

  CMS ownership
• Carthage Hospital, LLC

  • Rural Health Clinic/Center
  • Carthage, TX
  • NPI 1639678030

  Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

  CMS ownership
• East Texas Home Health Services LLC

  dba UT Health East Texas Home Health Services

  • Home Health Agency
  • Pittsburg, TX
  • NPI 1578061487

  East Texas Holdings, LLC

  CMS ownership
• East Texas Home Health Services LLC

  dba UT Health East Texas Home Health Services

  • Home Health Agency
  • Athens, TX
  • NPI 1760980668

  East Texas Holdings, LLC

  CMS ownership
• Encompass Health Rehabilitation Hospital of Amarillo, LLC

  dba Rehabilitation Hospital of Amarillo

  • Rehabilitation Hospital
  • Amarillo, TX
  • NPI 1487443099

  Ahp Health Partners, Inc, Ardent Health Inc, Ardent Legacy Holdings LLC

  CMS ownership
• Etmc Physician Group Inc.

  • Rural Health Clinic/Center
  • Chandler, TX
  • NPI 1235706581

  Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC, East Texas Holdings, LLC

  CMS ownership
• FMC - Lubbock LLC

  dba BSA Hospice of the Southwest

  • Community Based Hospice Care Agency
  • Amarillo, TX
  • NPI 1467447854

  Ardent Legacy Holdings LLC

  CMS ownership
• Henderson Hospital, LLC

  dba UTHealth East Texas Henderson Hospital

  • General Acute Care Hospital
  • Henderson, TX
  • NPI 1326546797

  Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

  CMS ownership

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

{
    "created_epoch": "1623024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623024000000",
    "number": "1689241945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BURTON HILLS BLVD STE 250",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156195",
            "telephone_number": "615-296-3594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MUNICIPAL DR STE 300",
            "city": "GUN BARREL CITY",
            "state": "TX",
            "postal_code": "751563703",
            "telephone_number": "903-713-1574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETMC PHYSICIAN GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-07",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A",
        "authorized_official_last_name": "PETROVICH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "EVP, GENERAL COUNSEL",
        "authorized_official_telephone_number": "615-296-3594"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rural Health Clinic/Center in Gun Barrel City, TX
• Providers in Gun Barrel City, TX by specialty
• Rural Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; 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.