NPIMap

Organization Active NPI

Bosque County Hospital District

  • Rural Health Clinic/Center
  • Whitney, TX
National Provider Identifier
1720540255
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BOSQUE COUNTY HOSPITAL DISTRICT
Practice address
202 E Jefferson Ave
Whitney, TX 76692-2398
Phone
(254) 694-2221
Fax
(254) 694-9978
NPI assigned
Apr 3, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

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

Authorized official

Name
Adam Willmann
Title
President/Ceo
Phone
(254) 675-8322

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

202 E Jefferson Ave
Whitney, TX 76692-2398

Mailing address

202 E Jefferson Ave
Whitney, TX 76692-2398
Phone (254) 694-2221

Other names 1

  • Goodall-Witcher Clinic in Whitney Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190610001433 TX Part A Provider - Rural Health Clinic 4587997754 Practice locations: Whitney, TX
O20190819000832 TX Part B Supplier - Clinic/Group Practice 4587997754 Receives reassigned benefits from 41 practitioners
2 other NPIs on this enrollment
Practice locations: Clifton, TX; Whitney, TX

Rural health clinic certification: CCN 673436

Legal name
BOSQUE COUNTY HOSPITAL DISTRICT
Doing business as
GOODALL-WITCHER CLINIC IN WHITNEY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 15, 2015
Last certification
Aug 2, 2024
Ownership / control type
Non-profit – church related
Most recent change of ownership
Jul 1, 2019 (1 total)
Organization structure
OtherNon-profit
Enrollment address
202 E Jefferson Ave
Whitney, TX 76692-2398
Related CCNs
451385

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.

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
45D0488453Goodall Witcher Clinic in Whitney202 E Jefferson Ave, Whitney, TX 76692Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

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.

NameRoleSinceShare
Vicki Gloff Individual Corporate DirectorController Dec 1, 2014
W-2 Managing EmployeeController Dec 1, 2014
Jerry L Pickett Individual W-2 Managing EmployeeCfo Jun 24, 2019
Charles Hopkins Individual Corporate OfficerBoard Director Jan 14, 2019
Roger Parks Individual Corporate OfficerSecretary/Treasurer Jan 14, 2019
Bosque County Hospital District Organization, Clifton, TX 5% Or Greater Direct Ownership Interest Jul 1, 2019 100%
Thomas Blossom Individual Corporate DirectorBoard Director May 22, 2020
Virginia Villarreal Individual Corporate OfficerBoard Director Jan 14, 2019
George Clifton Individual Corporate OfficerBoard Director Jan 14, 2019
Adam B Willmann Individual Corporate DirectorPresident/Ceo Dec 1, 2014
W-2 Managing EmployeePresident/Ceo Dec 1, 2014
Robert Phillips Individual Corporate OfficerBoard Director May 1, 2023
John Erickson Individual Corporate OfficerBoard Chairman Jan 14, 2019

Owners & managing parties with NPI records 5

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
Goodall-Witcher HospitalClifton, TX, CCN 45Z385 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 2019
Jul 1, 2019
Goodall-Witcher HospitalClifton, TX, CCN 451385 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 2019
Jul 1, 2019
Sunset HomeClifton, TX, CCN 675826 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Jul 1, 2019
Jul 1, 2019
Jul 2, 2025
Goodall-Witcher Home Health AgencyClifton, TX, CCN 457688 Home health agency 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2019
Goodall-Witcher Clinic in CliftonClifton, TX, CCN 673995 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2019

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.

Change-of-ownership history 1

DateEventCounterparty
Jul 1, 2019 Change of OwnershipThis provider was the buyer Lake Whitney Medical ClinicCCN 673436, TX, NPI 1336546266

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1554249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660089600000",
    "number": "1720540255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E JEFFERSON AVE",
            "city": "WHITNEY",
            "state": "TX",
            "postal_code": "766922398",
            "telephone_number": "254-694-2221",
            "fax_number": "254-694-9978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 E JEFFERSON AVE",
            "city": "WHITNEY",
            "state": "TX",
            "postal_code": "766922398",
            "telephone_number": "254-694-2221",
            "fax_number": "254-694-9978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSQUE COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-03",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A",
        "authorized_official_last_name": "WILLMANN",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "254-675-8322"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goodall-Witcher Clinic in Whitney",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Whitney, TX

Sources for this page

Verify at the official NPI Registry.