NPIMap

Organization Active NPI

Jack County Hospital District

Doing business as Faith Community Hospital

  • General Acute Care Hospital
  • Jacksboro, TX
National Provider Identifier
1790777696
Registry record updated Sep 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
100322 Issued in TX
Legal business name
JACK COUNTY HOSPITAL DISTRICT
Doing business as
Faith Community Hospital
Practice address
215 Chisholm TRL
Jacksboro, TX 76458
Phone
(940) 567-6633
Fax
(940) 567-2895
NPI assigned
Aug 17, 2005
Last updated
Sep 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2021

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

Authorized official

Name
Mrs. Kim Lee
Title
Coo
Phone
(940) 567-6633

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X TX
General Acute Care Hospital 282N00000X 000046 TX
General Acute Care Hospital 282N00000X 100322 TX Primary
Certified Registered Nurse Anesthetist 367500000X TX

Addresses

Primary practice location

215 Chisholm TRL
Jacksboro, TX 76458

Mailing address

215 Chisholm TRL
Jacksboro, TX 76458-1403
Phone (940) 567-6633

Other identifiers 5

IdentifierTypeStateIssuer
119874903MedicaidTX
HH0054OtherTXBC/BS PROVIDER NUMBER
119874905MedicaidTX
119874902MedicaidTX
119874904MedicaidTX

Other names 1

  • FAITH COMMUNITY HOSPITAL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040819000032 TX Part B Supplier - Clinic/Group Practice 5890768675 Receives reassigned benefits from 42 practitioners
Practice locations: Jacksboro, TX
O20100827000915 TX Part A Provider - Hospital 5890768675 1 other NPI on this enrollment
Practice locations: Bowie, TX; Jacksboro, TX
O20100831000407 TX Part A Provider - Hospital 5890768675 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jacksboro, TX

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1790777696. Details of each certification follow.

Hospital certification: CCN 450241

Legal name
JACK COUNTY HOSPITAL DISTRICT
Doing business as
FAITH COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Apr 20, 2022
Beds
41
Ownership / control type
Hospital district or authority
Organization structure
GovernmentNon-profit
Enrollment address
215 Chisholm Trail
Jacksboro, TX 76458-1403
Other Hospital Practice Location
Hospital subgroups
General, Acute care

Hospital certification: CCN 45U241

Legal name
JACK COUNTY HOSPITAL DISTRICT
Organization structure
GovernmentNon-profit
Enrollment address
215 Chisholm Trail
Jacksboro, TX 76458-1403
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

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

Other NPIs with the same Medicare PAC ID 1

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
Faith Community HospitalCCN 450241 · All quality measures
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Interoperability endpoints

  • Direct secure messaging: asantos@direct.fchtexas.com
  • Direct secure messaging: bshepherd@direct.fchtexas.com
  • Direct secure messaging: ecrutcher@direct.fchtexas.com
  • Direct secure messaging: jdunn@direct.fchtexas.com
  • Direct secure messaging: jjohnson@direct.fchtexas.com
  • Direct secure messaging: jlockyer@direct.fchtexas.com
  • Direct secure messaging: jsmith@direct.fchtexas.com
  • Direct secure messaging: pgafford@direct.fchtexas.com
  • Direct secure messaging: rcooper@direct.fchtexas.com
  • Direct secure messaging: sagarwal@direct.fchtexas.com

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
James Hammond Individual Corporate DirectorBoard Member Jan 1, 2015
Mark Maples Individual Corporate Director Aug 25, 2010
Lori McBrayer Individual Corporate DirectorBoard President Jan 1, 2015
Leslie Chalmers Individual Corporate DirectorEdc Director Jan 1, 2020
Corporate DirectorBoard Member Jan 1, 2020
Larry Hopwood Individual Corporate DirectorBoard Member Jan 1, 2015
Jack County Hospital District Organization, Jacksboro, TX Operational/Managerial Control Aug 25, 2010
Kim Lee Individual Corporate DirectorChief Financial Officer Oct 1, 2024
W-2 Managing EmployeeChief Operating Officer Sep 1, 2015
Frank L Beaman Individual Corporate DirectorCeo Sep 27, 2012
W-2 Managing Employee Jan 20, 2011
W-2 Managing EmployeeCeo Jan 20, 2011
Trina D Johnson Individual W-2 Managing EmployeeFinancial Analyst Oct 1, 2024

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 8

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

FacilityTypeRoleSince
Jack County Hospital DistrictJacksboro, TX, CCN 45U241 Hospital Operational/Managerial Control Aug 25, 2010
Avir at JacksboroJacksboro, TX, CCN 455808 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Sep 30, 2014
Park View Care CenterFort Worth, TX, CCN 455606 Skilled nursing facility 5% Or Greater Indirect Ownership Interest Oct 1, 2014
Arlington Residence and Rehabilitation CenterArlington, TX, CCN 455872 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Sep 30, 2013
Jack County Medical ClinicJacksboro, TX, CCN 673404 Rural health clinic Operational/Managerial Control Jun 1, 2010
FCH Rural Health Clinic BowieBowie, TX, CCN 673454 Rural health clinic Operational/Managerial Control May 1, 2017
FCH Rural Health Clinic AlvordAlvord, TX, CCN 673468 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 1, 2018
Nov 1, 2018
FCH Rural Health Clinic GrahamGraham, TX, CCN 673497 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 14, 2020
Oct 14, 2020

Owned or controlled facilities with NPI records 9

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

Facilities with the same owner 8

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 74

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

View all 74

NPI Registry JSON

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1790777696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 CHISHOLM TRL",
            "city": "JACKSBORO",
            "state": "TX",
            "postal_code": "764581403",
            "telephone_number": "940-567-6633",
            "fax_number": "940-567-2895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 CHISHOLM TRL",
            "city": "JACKSBORO",
            "state": "TX",
            "postal_code": "76458",
            "telephone_number": "940-567-6633",
            "fax_number": "940-567-2895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-17",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "940-567-6633",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TX",
            "license": "000046",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TX",
            "license": "100322",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119874903",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER NUMBER",
            "identifier": "HH0054",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119874905",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119874902",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119874904",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAITH COMMUNITY HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksboro, TX

Sources for this page

Verify at the official NPI Registry.