NPIMap

Organization Active NPI

Sid Peterson Memorial Hospital

Doing business as Peterson Regional Medical Center

  • Rural Acute Care Hospital
  • Kerrville, TX
National Provider Identifier
1790782704
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
License
000406 Issued in TX
Legal business name
SID PETERSON MEMORIAL HOSPITAL
Doing business as
Peterson Regional Medical Center
Practice address
551 Hill Country Dr
Kerrville, TX 78028-6085
Phone
(830) 896-4200
Fax
(830) 258-7678
NPI assigned
Jul 5, 2005
Last updated
Jul 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2022

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

Authorized official

Name
Lisa Medovich
Title
Cfo
Phone
(830) 258-7632

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Rural Acute Care Hospital 282NR1301X 000406 TX Primary

Addresses

Primary practice location

551 Hill Country Dr
Kerrville, TX 78028-6085

Mailing address

551 Hill Country Dr
Kerrville, TX 78028-6085
Phone (830) 896-4200

Other names 1

  • PETERSON REGIONAL MEDICAL CENTER Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031111000441 TX Part A Provider - Hospital 6002724887 Practice locations: Kerrville, TX; Comfort, TX
O20071213000738 TX Part B Supplier - Clinic/Group Practice 6002724887 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
Practice locations: Kerrville, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790782704. Details of each certification follow.

Hospital certification: CCN 450007

Legal name
SID PETERSON MEMORIAL HOSPITAL
Doing business as
PETERSON COMMUNITY CARE CLINIC RHC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 27, 2024
Beds
124
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 13, 1989 in TX
Enrollment address
551 Hill Country Dr
Kerrville, TX 78028-6085
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

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

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Peterson Regional Medical CenterCCN 450007 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Progressive Health Cent6 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.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

535 Hill Country Dr
Kerrville, TX 78028

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Gaye Avery Individual Corporate DirectorBoard Member Jul 1, 2024
Michael D Ross Individual Corporate DirectorBoard Member Jul 1, 2024
Norman Williams Individual Corporate DirectorBoard Member Jul 1, 2022
Toni Manchester Individual Corporate DirectorBoard Member Jul 1, 2022
Rose Bradshaw Individual Corporate DirectorBoard Member Jul 1, 2022
Bobby Templton Individual Corporate Director Jul 1, 2026
James a Young Individual Corporate DirectorBoard Member Apr 8, 2019
Lisa M Medovich Individual Corporate OfficerCfo Apr 8, 2019
W-2 Managing EmployeeCfo Apr 8, 2019
Brian P Bowers Individual Corporate DirectorBoard Member Apr 8, 2019
Sid Peterson Memorial Hospital Organization, Kerrville, TX 5% Or Greater Direct Ownership Interest Jan 1, 1990
Operational/Managerial Control Jan 1, 1990
Joseph Thomas Piszczor Individual Corporate OfficerCoo Jul 14, 2020
W-2 Managing Employee Jul 14, 2020
Jeremy Walther Individual Corporate DirectorBoard Member Jul 1, 2024
Kendall Davison Individual Corporate DirectorBoard Member Jul 1, 2023
Johnathan W McDonald Individual Corporate OfficerPresident/Ceo May 27, 2025
W-2 Managing EmployeePresident/Ceo May 27, 2025
Christopher Ballesteros Individual W-2 Managing EmployeeCompliance Officer Jun 18, 2020
Thomas Houdeshell Individual Corporate DirectorBoard Member Jul 1, 2020
Kristen McAlexander 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 4

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

FacilityTypeRoleSince
Peterson Regional Medical CenterKerrville, TX, CCN 45T007 Hospital Operational/Managerial Control Jan 1, 1990
Peterson Home CareKerrville, TX, CCN 677052 Home health agency Operational/Managerial Control Feb 13, 2007
Peterson HospiceKerrville, TX, CCN 671585 Hospice 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 26, 2007
Apr 26, 2007
Peterson Community Care Clinic RHCKerrville, TX, CCN 678558 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 1990
Jan 1, 1990

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 37

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 37

Affiliated clinicians 473

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

View all 473

NPI Registry JSON

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658880000000",
    "number": "1790782704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "551 HILL COUNTRY DR",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780286085",
            "telephone_number": "830-896-4200",
            "fax_number": "830-258-7678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "551 HILL COUNTRY DR",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780286085",
            "telephone_number": "830-896-4200",
            "fax_number": "830-258-7678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SID PETERSON MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-05",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A",
        "authorized_official_last_name": "MEDOVICH",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "830-258-7632"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "TX",
            "license": "000406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PETERSON REGIONAL MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PETERSON REGIONAL MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kerrville, TX

Sources for this page

Verify at the official NPI Registry.