Active NPI
Jacksonville Hospital LLC
Doing business as UTHealth East Texas Jacksonville Hospital
- General Acute Care Hospital
- Jacksonville, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Acute Care Hospital
- Legal business name
- JACKSONVILLE HOSPITAL LLC
- Doing business as
- UTHealth East Texas Jacksonville Hospital
- Practice address
- 501 S Ragsdale St
Jacksonville, TX 75766-2434 - Phone
- (903) 541-5083
- Fax
- (903) 541-5068
- NPI assigned
- Jan 17, 2018
- Last updated
- Sep 20, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Stephen C Petrovich
- Title
- Evp and Secretary
- Phone
- (615) 296-3000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | Primary |
Addresses
Primary practice location
501 S Ragsdale St
Jacksonville, TX 75766-2434
Mailing address
340 Seven Springs Way Ste 100
Brentwood, TN 37027-5697
Phone (615) 296-3000
Other names 1
- UTHealth East Texas Jacksonville Hospital
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180427000653 | TX | Part A Provider - Hospital | 4284996638 | Practice locations: Jacksonville, TX |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1730697350. Details of each certification follow.
Hospital certification: CCN 450194
- Legal name
- JACKSONVILLE HOSPITAL LLC
- Doing business as
- UT HEALTH EAST TEXAS JACKSONVILLE HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Oct 23, 2025
- Beds
- 74 (65 certified)
- Ownership / control type
- Private (for profit)
- Most recent change of ownership
- Mar 1, 2018 (2 total)
- Organization structure
- LLC
- Incorporated
- Dec 19, 2017 in DE
- Enrollment address
- 501 S Ragsdale St
Jacksonville, TX 75766-2434 - Hospital subgroups
- Acute care
Related certifications (CCN) 3
Facilities connected through Provider of Services related, parent or unit certification numbers.
-
- Rural Health Clinic/Center
- Jacksonville, TX
- NPI 1861991226
Parent provider
Other NPIs with the same Medicare PAC ID 3
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Care Compare: Hospital
Medicare Care Compare- Listed as
- Ut Health East Texas Jacksonville Hospital
- Type
- Acute Care Hospitals
- Ownership
- Proprietary
- Medicare certification status
- Active
- Emergency services
- Yes
National Provider Directory
National Provider Directory- Tax ID family
- Jacksonville Hospital LLC
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Rural Health Clinic/Center
- Frankston, TX
- NPI 1043719560
-
- Rural Health Clinic/Center
- Rusk, TX
- NPI 1770082299
-
- Rural Health Clinic/Center
- Jacksonville, TX
- NPI 1861991226
Ownership & related parties
All disclosed owners & managing parties 10
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Ardent Health Inc | 5% Or Greater Indirect Ownership Interest | Mar 1, 2018 | 100% |
| Ahs Texas, LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2019 | 100% |
| Martin Bonick | Corporate Officer | Aug 20, 2020 | |
| Mary a Crabtree | Corporate Officer | Mar 1, 2018 | |
| Ahs Management Company Inc. | Operational/Managerial Control | Mar 1, 2018 | |
| Stephen C Petrovich | Corporate Officer | Mar 1, 2018 | |
| Ardent Legacy Holdings LLC | 5% Or Greater Indirect Ownership Interest | Mar 1, 2018 | 100% |
| Ahs East Texas Health System, LLC | 5% Or Greater Direct Ownership Interest | Mar 1, 2018 | 100% |
| Donald Baker | Corporate Officer | Nov 1, 2020 | 100% |
| W-2 Managing Employee | Nov 1, 2020 | 100% | |
| Ahp Health Partners, Inc | 5% Or Greater Indirect Ownership Interest | Mar 1, 2018 | 100% |
Facilities with the same owner 61
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- 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
-
- General Acute Care Hospital
- Amarillo, TX
- NPI 1407191984
Ahp Health Partners, Inc, Ahs Management Company Inc., Ardent Health Inc, Ardent Legacy Holdings LLC
-
- Rehabilitation Hospital Unit
- Amarillo, TX
- NPI 1730425190
Ahp Health Partners, Inc, Ahs Management Company Inc., Ardent Health Inc, Ardent Legacy Holdings 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
-
- 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
-
- 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
-
dba Rehabilitation Hospital of Amarillo
- Rehabilitation Hospital
- Amarillo, TX
- NPI 1487443099
Ahp Health Partners, Inc, Ardent Health Inc, Ardent Legacy Holdings LLC
-
- 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
-
- Rural Health Clinic/Center
- Gun Barrel City, TX
- NPI 1689241945
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
-
dba BSA Hospice of the Southwest
- Community Based Hospice Care Agency
- Amarillo, TX
- NPI 1467447854
Ardent Legacy Holdings 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
-
- Rural Health Clinic/Center
- Henderson, TX
- NPI 1952800310
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
Practitioners & affiliated clinicians
Practitioners 9
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.
-
- Obstetrics & Gynecology Physician
- Jacksonville, TX
- NPI 1528312121
-
- Hospitalist Physician
- Jacksonville, TX
- NPI 1588637698
-
- Hospitalist Physician
- Tyler, TX
- NPI 1265991566
-
- Obstetrics Physician
- Jacksonville, TX
- NPI 1154310688
-
- Family Medicine Physician
- Jacksonville, TX
- NPI 1255061883
-
- Pediatrics Physician
- Jacksonville, TX
- NPI 1265727457
-
- Pediatrics Physician
- Houston, TX
- NPI 1780979336
-
- Pediatrics Physician
- Roswell, GA
- NPI 1073788444
-
- Pediatrics Physician
- Chicago, IL
- NPI 1750469987
Affiliated clinicians 143
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Tyler, TX
- NPI 1003887407
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516147200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1695168000000",
"number": "1730697350",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 SEVEN SPRINGS WAY STE 100",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370275697",
"telephone_number": "615-296-3000",
"fax_number": "615-296-6227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 S RAGSDALE ST",
"city": "JACKSONVILLE",
"state": "TX",
"postal_code": "757662434",
"telephone_number": "903-541-5083",
"fax_number": "903-541-5068"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JACKSONVILLE HOSPITAL LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-01-17",
"last_updated": "2023-09-20",
"certification_date": "2023-09-20",
"status": "A",
"authorized_official_last_name": "PETROVICH",
"authorized_official_first_name": "STEPHEN",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "EVP AND SECRETARY",
"authorized_official_telephone_number": "615-296-3000"
},
"taxonomies": [
{
"code": "282N00000X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "UTHealth East Texas Jacksonville Hospital",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Jacksonville, TX
- Jeffrey Thomas Hunter, M.D.
- J.Michael Hatchett, DDS, PC Mark Allan Thompson, DDS, PC
- Andrew Jay Jackson
- Jacksonville Health Care
- Jacksonville Hospital LLC
- Jacksonville Hospital LLC
- Jacksonville I Enterprises LLC (The Trinity Assisted Living of Jacksonville)
- Jacksonville Independent School District
- Jacksonville Opco, LLC (Angelina House)
- Jacksonville SCC, LLC (Senior Care of Jacksonville)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; 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.