Memorial Medical Center
Organization Active NPI Critical Access Hospital · Port Lavaca, TX
NPI 1689630865 · NPPES record last updated Mar 2, 2026
Key facts
- NPI
- 1689630865
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 000487 (TX)
- Legal business name
- MEMORIAL MEDICAL CENTER
- Practice address
- 815 N Virginia St
Port Lavaca, TX 77979-3025 - Phone
- (361) 552-6713
- Fax
- (361) 552-0338
- NPI assigned
- Apr 25, 2006
- Organization subpart
- No
Authorized official
- Name
- Erin Clevenger
- Title
- Ceo
- Phone
- (361) 552-0240
Owners & managing parties with NPI records 7
-
Don Paul Bunnell, MD
-
Rhonda Kay Nielsen, D.D.S.
Owned or controlled facilities with NPI records 3
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 5
Related certifications (CCN) 2
Facilities with the same owner 3
Practitioners 49
-
Jerry Lee Followwill, M.D.
-
Michael Leon Gaines, FNP-C
-
Joseph Dillon Jenkins, D.O.
-
Tasha Norman, MSN, APRN, FNP-C
-
Mercedes Schultz, MD
-
Traci Shefcik, FNP
-
Courtne L Thurlkill, FNP
-
William J Crowley III, D.O.
-
Don Paul Bunnell, MD
-
James A Winters II, CRNA
-
Lisa Diane Blacketter, CRNA
-
Salam Izdain Gharaybeh, M.D.
-
Adam Nicholas Myers, CRNA
-
Haley Yarbrough, CRNA
-
Randall M Barron, DO
-
Karlan J Downing, M.D.
-
Frank Christopher Hinds, M.D.
-
Richard Francis Lorenz, D.O.
-
June Mabry, M.D.
Affiliated clinicians 104
-
Ashraf Abusara, MD
-
Ayo Adu, M.D.
-
Jeremiah E Bast, FNP-C
-
Bruce Bauknight, MD
-
Lisa Diane Blacketter, CRNA
-
Rhonda Bludau, NP
-
Jennifer Foxell Bluntzer, DNP, APRN, ACAGNP-BC
-
Terry B Brasher, MPAS,PA-C
-
Donald W. Breech, M.D.
-
Thomas David Burgess, D.O.
-
Eliezer Castaneda, M.D.
-
Michael Caughron, FNP-C
-
Kishan Chand, M.D.
-
Harish Chandna, MD
-
Sabrina S Chen, DO
-
Ryan David Cradeur, M.D.
-
William J Crowley III, D.O.
-
Michelle Cummins, MD
Medicare Care Compare: Hospital
- Listed as
- Memorial Medical Center
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Critical Access Hospitals
- Ownership
- Government - Local
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in TX
Hospital certification: CCN 451356
- Legal name
- MEMORIAL MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Aug 1, 2004
- Last certification
- Feb 13, 2019
- Beds
- 25
- Ownership / control type
- Local
- Organization structure
- Government · Non-profit
- Incorporated
- Jul 14, 1947 in TX
- Enrollment address
- 815 N Virginia St
Port Lavaca, TX 77979-3025
Hospital certification: CCN 45Z356
- Legal name
- MEMORIAL MEDICAL CENTER
- Organization structure
- Other · Non-profit
- Incorporated
- Jul 14, 1947 in TX
- Enrollment address
- 815 N Virginia St
Port Lavaca, TX 77979-3025
Rural health clinic certification: CCN 673422
- Legal name
- MEMORIAL MEDICAL CENTER
- Doing business as
- MEMORIAL MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Dec 17, 2014
- Last certification
- May 4, 2021
- Ownership / control type
- 2A
- Organization structure
- Other · Non-profit
- Incorporated
- Jul 14, 1947 in TX
- Enrollment address
- 1016 N Virginia St
Memorial Medical Center Clinic
Port Lavaca, TX 77979-3000 - Related CCNs
- 451356
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Erin Clevenger |
Corporate Officer |
Apr 1, 2024 | 100% |
| W-2 Managing Employee |
Apr 1, 2024 | 100% | |
| Operational/Managerial Control |
Apr 1, 2024 | 100% | |
| W-2 Managing Employee |
Apr 1, 2025 | 100% | |
| Operational/Managerial Control |
Apr 1, 2025 | 100% | |
| Jack Wu |
Corporate Director | Nov 1, 1988 | |
| Rolando Reyes |
Corporate Director |
Jan 1, 1982 | 10% |
| Corporate Director |
Jan 1, 1982 | 10% | |
| Memorial Medical Center |
Operational/Managerial Control | Jan 1, 1966 | 100% |
| Operational/Managerial Control | Dec 31, 2021 | 100% | |
| Russell Cain |
Corporate Director |
Jun 1, 2008 | 10% |
| Corporate Director |
Jun 1, 2008 | 10% | |
| Don P Bunnell |
Corporate Director |
Mar 31, 2016 | 10% |
| Corporate Director |
Mar 22, 2016 | 10% | |
| Susan K Foester |
Corporate Director |
Mar 31, 2012 | 10% |
| Corporate Director | Mar 31, 2012 | 10% | |
| Rhonda Kay Nielsen |
Corporate Director |
Mar 31, 2016 | 10% |
| Corporate Director | Mar 22, 2016 | 10% | |
| Michael Chavana |
Corporate Director |
Mar 31, 2012 | 10% |
| Diane C Moore |
Corporate Officer |
May 10, 2018 | 50% |
| Operational/Managerial Control |
May 10, 2018 | 50% | |
| Jerry L Pickett |
Corporate Officer |
May 18, 2015 | 25% |
| W-2 Managing Employee |
May 18, 2016 | 25% | |
| Roshanda S Thomas |
W-2 Managing Employee |
Dec 31, 2021 | 100% |
| Operational/Managerial Control |
Dec 31, 2021 | 100% | |
| Jason W Anglin |
Corporate Officer | Jun 30, 2010 | |
| W-2 Managing Employee |
Jun 30, 2010 | 50% |
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Golden Creek Healthcare and Rehabilitation Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| Lavaca Bay Nursing and Rehabilitation Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Mar 4, 2020 Mar 4, 2020 Feb 27, 2025 |
| Tuscany Village |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040316000136 | TX | Part B Supplier - Clinic/Group Practice | 3072403096 |
Receives reassigned benefits from 11 practitioners 1 other NPI on this enrollment Practice locations: Port Lavaca, TX |
| O20110414000718 | TX | Part a Provider - Critical Access Hospital | 3072403096 |
Receives reassigned benefits from 5 practitioners Practice locations: Port Lavaca, TX |
| O20120301000191 | TX | Part a Provider - Critical Access Hospital | 3072403096 |
Receives reassigned benefits from 1 practitioner Practice locations: Port Lavaca, TX |
| O20141022000403 | TX | Part a Provider - Rural Health Clinic | 3072403096 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Port Lavaca, TX |
National Provider Directory
Locations
1866 N Orange Grove Ave
Ste 104
Pomona, CA 91767
Phone (909) 591-6414
1016 N Virginia St
Port Lavaca, TX 77979
Phone (361) 552-0325
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | 000487 | TX | Yes |
Addresses
Primary practice location
815 N Virginia St
Port Lavaca, TX 77979-3025
Mailing address
815 N Virginia St
Port Lavaca, TX 77979-3025
Phone (361) 552-6713
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 137909104 | Medicaid | TX | |
| 137909107 | Medicaid | TX | |
| 137909111 | Medicaid | TX | |
| 137909101 | Medicaid | TX | |
| 022476801 | Medicaid | TX | |
| 142448301 | Medicaid | TX | |
| HH0489 | Other | TX | BLUE CROSS |
| 137909103 | Medicaid | TX |
Other providers in Port Lavaca, TX
- William John McFarland
- Memorial Medical Center
- Memorial Medical Center
- Memorial Medical Center
- Memorial Medical Center
- Memorial Medical Clinic
- Memorial Medical Clinic
- Kelly Leigh Meyer
- Torri Reann Mikolas
- Vrinda Mohunta
All providers in Port Lavaca, TX · Critical Access Hospital in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.