NPIMap

Organization Active NPI

Pecos County Memorial Hospital District

  • Medicare Defined Swing Bed Hospital Unit
  • Fort Stockton, TX
National Provider Identifier
1720861107
Registry record updated Aug 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
PECOS COUNTY MEMORIAL HOSPITAL DISTRICT
Practice address
387 W Ih 10
Fort Stockton, TX 79735-2708
Phone
(432) 336-4200
NPI assigned
Aug 17, 2023
Last updated
Aug 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2023

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

Authorized official

Name
Betsy L Briscoe
Title
Chief Executive Officer
Phone
(432) 336-4201

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X NU Primary

Addresses

Primary practice location

387 W Ih 10
Fort Stockton, TX 79735-2708

Mailing address

PO Box 1648
Fort Stockton, TX 79735-1648
Phone (432) 336-4200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231004000831 TX Part A Provider - Critical Access Hospital 3173977477 Practice locations: Fort Stockton, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720861107. Details of each certification follow.

Hospital certification: CCN 45Z389

Legal name
PECOS COUNTY MEMORIAL HOSPITAL DISTRICT
Doing business as
PECOS COUNTY MEMORIAL HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
387 W Ih 10
Fort Stockton, TX 79735-2708
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Pecos County Memorial Hospital District6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

387 W Interstate 10
Fort Stockton, TX 79735
Phone (432) 336-2004

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Rebecca Ureta Individual Corporate DirectorChief Financial Officer Jul 1, 2023
W-2 Managing EmployeeChief Financial Officer Jul 1, 2023
Operational/Managerial ControlChief Financial Officer Jul 1, 2023
Pecos County Memorial Hospital District Organization, Fort Stockton, TX 5% Or Greater Direct Ownership Interest Jul 1, 2023
Operational/Managerial Control Jul 1, 2023
Armando Mandujano Individual Corporate DirectorBoard Member Jul 1, 2023
Matt Tarpley Individual Corporate DirectorBoard Member Jul 1, 2023
Lou Ann Tovar Individual Corporate DirectorBoard Member Jul 1, 2023
Betsy Briscoe Individual Corporate DirectorChief Executive Officer Jul 1, 2023
W-2 Managing EmployeeChief Executive Officer Jul 1, 2023
Operational/Managerial ControlChief Executive Officer Jul 1, 2023
Santiago Cantu Individual Corporate DirectorBoard Member Jul 1, 2023
Laura McKenzie Individual Corporate DirectorBoard Member Jul 1, 2023

Owners & managing parties with NPI records 6

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
Pecos County Memorial Hospital DistrictFort Stockton, TX, CCN 451389 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2023
Jul 1, 2023
Pecos County Memorial Hospital Home Health & HospiceFort Stockton, TX, CCN 673107 Home health agency 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jun 1, 2023
Jun 1, 2023
Pecos County Memorial Hospital HospiceFort Stockton, TX, CCN 671732 Hospice 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2023
Jul 1, 2023

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1692230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692230400000",
    "number": "1720861107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1648",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "797351648",
            "telephone_number": "432-336-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 W IH 10",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "797352708",
            "telephone_number": "432-336-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECOS COUNTY MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-17",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "BRISCOE",
        "authorized_official_first_name": "BETSY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "432-336-4201"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Stockton, TX

Sources for this page

Verify at the official NPI Registry.