NPIMap

Organization Active NPI

De Craig Ranch, LLC

Doing business as Dignity Health St Rose Dominican West Flamingo Campus

  • General Acute Care Hospital
  • Las Vegas, NV
National Provider Identifier
1740724780
Registry record updated Oct 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
DE CRAIG RANCH, LLC
Doing business as
Dignity Health St Rose Dominican West Flamingo Campus
Practice address
9880 W Flamingo Rd
Las Vegas, NV 89147
Phone
(713) 637-1146
Fax
(281) 298-5311
NPI assigned
Dec 9, 2016
Last updated
Oct 23, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
DE CRAIG RANCH, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 23, 2018

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

Authorized official

Name
John Buck
Title
President
Phone
(713) 637-1004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NU Primary

Addresses

Primary practice location

9880 W Flamingo Rd
Las Vegas, NV 89147

Mailing address

8686 New Trails Dr
Suite 100
The Woodlands, TX 77381-1176
Phone (713) 637-1146

Other identifiers 2

IdentifierTypeStateIssuer
29-0058OtherMEDICARE
1740724780MedicaidNV

Other names 1

  • Dignity Health St Rose Dominican West Flamingo Campus Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170818002615 NV Part A Provider - Hospital 6002183563 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Las Vegas, NV; North Las Vegas, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740724780. Details of each certification follow.

Hospital certification: CCN 290058

Legal name
DE CRAIG RANCH LLC
Doing business as
DIGNITY HEALTH ST ROSE DOMINICAN NORTH LAS VEGAS CAMPUS
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Oct 23, 2017
Last certification
Oct 23, 2017
Beds
32
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Feb 11, 2016 in NV
Enrollment address
1550 W Craig Rd
Ste 100
North Las Vegas, NV 89032-0329
Other Hospital Practice Location
Hospital subgroups
Acute care

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Saint Rose Dominican Hospitals - North Las VegasCCN 290058 · All quality measures
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
29D2129185Dignity St Rose - Flamingo9880 W Flamingo Rd, Las Vegas, NV 89147AccreditationMar 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
De Craig Ranch LLC5 organizations share this tax ID, including this one
Part of
De Craig Ranch LLC

Other organizations with this tax ID 4

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

  • De Craig Ranch LLC

    dba Dignity Health - St. Rose Dominican North Durango Campus

    • General Acute Care Hospital
    • Las Vegas, NV
    • NPI 1073329223
    NPD tax ID
  • De Craig Ranch, LLC

    dba Dignity Health-St Rose Dominican Sahara

    • General Acute Care Hospital
    • Las Vegas, NV
    • NPI 1457895336
    NPD tax ID
  • De Craig Ranch, LLC

    dba Dignity Health-St. Rose Dominican North Las Vegas Campus

    • General Acute Care Hospital
    • North Las Vegas, NV
    • NPI 1578007514
    NPD tax ID
  • De Craig Ranch, LLC

    dba Dignity Health-St. Rose Dominican Blue Diamond Campus

    • General Acute Care Hospital
    • Las Vegas, NV
    • NPI 1922542968
    NPD tax ID

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Homer D Kirby Individual 5% Or Greater Indirect Ownership InterestIn-Direct Owner May 11, 2012 9%
Vanessa Smith Individual Corporate DirectorBoard Member Apr 17, 2020
W-2 Managing Employee Apr 17, 2020
Emerus Group Holdings LP Organization, New York, NY Holding company 5% Or Greater Indirect Ownership Interest Sep 1, 2015 49%
Dignity Health Organization, The Woodlands, TX Corporation 5% Or Greater Indirect Ownership Interest May 5, 2016 51%
Victor Schmerbeck Individual Corporate OfficerPresident Feb 15, 2020
W-2 Managing EmployeeBoard Member Feb 15, 2020
John E Buck Individual Corporate OfficerSecretary Jun 16, 2016
W-2 Managing Employee May 16, 2016
Emerus Intermediate Holdings Inc Organization, New York, NY Corporation, Holding company 5% Or Greater Indirect Ownership Interest Sep 1, 2015 49%
Toby R Hamilton Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2015 5.92%
Jaba Interest LLC Organization, The Woodlands, TX LLC 5% Or Greater Indirect Ownership Interest Oct 16, 2015 10%
Hemant Vankawala Individual 5% Or Greater Indirect Ownership InterestIn-Direct Owner May 11, 2012 7%
Linda Tautz Individual Corporate DirectorBoard Member Jun 2, 2021
Brian D Kleven Individual Corporate OfficerSecretary Aug 2, 2022
Corporate DirectorBoard Member Dec 12, 2019
Emerus Investment Company V, LLC Organization, The Woodlands, TX Corporation 5% Or Greater Indirect Ownership Interest May 4, 2016 49%
Emerus Holdings, Inc. Organization, The Woodlands, TX Corporation, For-profit 5% Or Greater Indirect Ownership Interest Sep 1, 2015 49%
Welsh Carson Anderson & Stowe XII, LP Organization, New York, NY 5% Or Greater Indirect Ownership Interest Sep 1, 2015 19.37%
De JV LLC Organization, The Woodlands, TX For-profit 5% Or Greater Direct Ownership Interest May 5, 2016 100%

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 64

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 64

Affiliated clinicians 93

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

View all 93

NPI Registry JSON

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

{
    "created_epoch": "1481241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540252800000",
    "number": "1740724780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8686 NEW TRAILS DR",
            "address_2": "SUITE 100",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773811176",
            "telephone_number": "713-637-1146",
            "fax_number": "281-298-5311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9880 W FLAMINGO RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89147",
            "telephone_number": "713-637-1146",
            "fax_number": "281-298-5311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DE CRAIG RANCH, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DE CRAIG RANCH, LLC",
        "enumeration_date": "2016-12-09",
        "last_updated": "2018-10-23",
        "status": "A",
        "authorized_official_last_name": "BUCK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "713-637-1004"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "29-0058",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740724780",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dignity Health St Rose Dominican West Flamingo Campus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.