NPIMap

Organization Active NPI

Memorial Medical Center

  • Critical Access Hospital
  • Port Lavaca, TX
National Provider Identifier
1689630865
Registry record updated Mar 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
000487 Issued in 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
Last updated
Mar 2, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2026

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

Authorized official

Name
Erin Clevenger
Title
Ceo
Phone
(361) 552-0240

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 000487 TX Primary

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 8

IdentifierTypeStateIssuer
022476801MedicaidTX
137909103MedicaidTX
137909107MedicaidTX
137909101MedicaidTX
142448301MedicaidTX
137909104MedicaidTX
137909111MedicaidTX
HH0489OtherTXBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1689630865. Details of each certification follow.

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
GovernmentNon-profit
Incorporated
Jul 14, 1947 in TX
Enrollment address
815 N Virginia St
Port Lavaca, TX 77979-3025
Other Hospital Practice Location

Hospital certification: CCN 45Z356

Legal name
MEMORIAL MEDICAL CENTER
Organization structure
OtherNon-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
OtherNon-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

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

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

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
Memorial Medical CenterCCN 451356 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member organizations 5

Organizations listed as members of this organization in the National Provider Directory.

Locations

815 N Virginia St
Ste 101
Port Lavaca, TX 77979
Phone (361) 552-0379

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Erin Clevenger Individual Corporate OfficerCeo Apr 1, 2024 100%
W-2 Managing EmployeeAd; Apr 1, 2024 100%
Operational/Managerial ControlCeo Apr 1, 2024 100%
W-2 Managing EmployeeAd; Apr 1, 2025 100%
Operational/Managerial ControlCeo Apr 1, 2025 100%
Jack Wu Individual Corporate Director Nov 1, 1988
Rolando Reyes Individual Corporate DirectorVice Chairman of the Board Jan 1, 1982 10%
Corporate DirectorVice Charman of the Board Jan 1, 1982 10%
Memorial Medical Center Organization, Port Lavaca, TX Operational/Managerial Control Jan 1, 1966 100%
Operational/Managerial Control Dec 31, 2021 100%
Russell Cain Individual Corporate DirectorChariman of the Board Jun 1, 2008 10%
Corporate DirectorChairman of the Board Jun 1, 2008 10%
Don P Bunnell Individual Corporate DirectorBoard Member Mar 31, 2016 10%
Corporate DirectorBoard Member/Medical Staff Chairman Mar 22, 2016 10%
Susan K Foester Individual Corporate DirectorBoard Member Mar 31, 2012 10%
Corporate Director Mar 31, 2012 10%
Rhonda Kay Nielsen Individual Corporate DirectorBoard Member Mar 31, 2016 10%
Corporate Director Mar 22, 2016 10%
Michael Chavana Individual Corporate DirectorSecretary of the Board Mar 31, 2012 10%
Diane C Moore Individual Corporate OfficerCfo May 10, 2018 50%
Operational/Managerial ControlCfo May 10, 2018 50%
Jerry L Pickett Individual Corporate OfficerCfo May 18, 2015 25%
W-2 Managing EmployeeCfo May 18, 2016 25%
Roshanda S Thomas Individual W-2 Managing EmployeeInterim Ceo Dec 31, 2021 100%
Operational/Managerial ControlInterim Ceo Dec 31, 2021 100%
Jason W Anglin Individual Corporate Officer Jun 30, 2010
W-2 Managing EmployeeCeo Jun 30, 2010 50%

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Golden Creek Healthcare and Rehabilitation CenterNavasota, TX, CCN 676097 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Lavaca Bay Nursing and Rehabilitation CenterPort Lavaca, TX, CCN 676481 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 VillagePearland, TX, CCN 676201 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2020

Owned or controlled facilities with NPI records 3

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

  • Memorial Medical Center

    dba Tuscany Village

    • Skilled Nursing Facility
    • Pearland, TX
    • NPI 1275717894

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Memorial Medical Center

    dba Lavaca Bay Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Port Lavaca, TX
    • NPI 1538719836

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

    CMS ownership
  • Memorial Medical Center

    dba Golden Creek Healthcare and Rehabilitation Center

    • Skilled Nursing Facility
    • Navasota, TX
    • NPI 1588075964

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 44

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.

View all 44

Affiliated clinicians 104

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

View all 104

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772409600000",
    "number": "1689630865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 N VIRGINIA ST",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "779793025",
            "telephone_number": "361-552-6713",
            "fax_number": "361-552-0338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 N VIRGINIA ST",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "779793025",
            "telephone_number": "361-552-6713",
            "fax_number": "361-552-0338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2026-03-02",
        "certification_date": "2026-03-02",
        "status": "A",
        "authorized_official_last_name": "CLEVENGER",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "361-552-0240"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "TX",
            "license": "000487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022476801",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137909103",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137909107",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137909101",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142448301",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137909104",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137909111",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "HH0489",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Lavaca, TX

Sources for this page

Verify at the official NPI Registry.