Sid Peterson Memorial Hospital
Organization Active NPI Rural Acute Care Hospital · Kerrville, TX
NPI 1790782704 · NPPES record last updated Jul 27, 2022
Key facts
- NPI
- 1790782704
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Acute Care Hospital 282NR1301X
- License
- 000406 (TX)
- Legal business name
- SID PETERSON MEMORIAL HOSPITAL
- Practice address
- 551 Hill Country Dr
Kerrville, TX 78028-6085 - Phone
- (830) 896-4200
- Fax
- (830) 258-7678
- NPI assigned
- Jul 5, 2005
- Organization subpart
- No
Authorized official
- Name
- Lisa Medovich
- Title
- Cfo
- Phone
- (830) 258-7632
Owners & managing parties with NPI records 6
-
Michael D. Ross, MD
-
James Alan Young, MD
Owned or controlled facilities with NPI records 4
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 5
Related certifications (CCN) 2
Facilities with the same owner 4
Practitioners 37
-
Vanessa R Cox, DNP, APRN, FNP-BC
-
Brittany Holder, FNP
-
Deepti Nagpal, AGCNS
-
Frank Pawlak, FNP-C
-
James Alan Young, MD
-
Sandra Kay Bradley, RNC, BSN, NNP
-
Sharrel M Carlton, M.D.
-
Jennifer Carney, RN, NNP-BC
-
Katia Castillo, ACNP
-
Martha L. Flagg, NP
-
Janet Hilsabeck, NNP
-
Katlyn Hoover, MD
-
Ashley M. Johnson, CNM
-
Lisa Ann Karp, NNP-BC
-
Niessa Collette Meier, RN, CNM
-
Sherry Michele Mullins, PA-C
Affiliated clinicians 473
-
Ali Abedi, M.D.
-
Michael Abel, MD
-
Margaret Abuzeid, M.D.
-
Luis Jose Acosta, M.D.
-
Shari Addington, MD
-
Lise Valerie Agnant Malebranche, M.D, MPH, MBA
-
Billy Jack Aguilar, N.P.
-
Fadi Al-Saiegh, M.D.
-
Sindhura Alapati, M.D
-
Ladislau Albert Jr., M.D.
-
Lawrence A Alder, M.D.
-
Diana Janett Alvarado, PA-C
-
Jorge A Alvarez, MD
-
Iliana Arellano, MD
-
Adriana Arguello, MD
-
Gustavo Andres Arismendi, FNP-C
-
Heather Armstrong, MSN, APRN, FNP-C
Medicare Care Compare: Hospital
- Listed as
- Peterson Regional Medical Center
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
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
- Corporation · Non-profit
- Incorporated
- Feb 13, 1989 in TX
- Enrollment address
- 551 Hill Country Dr
Kerrville, TX 78028-6085 - Hospital subgroups
- General, Acute care
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Gaye Avery |
Corporate Director |
Jul 1, 2024 | |
| Michael D Ross |
Corporate Director |
Jul 1, 2024 | |
| Norman Williams |
Corporate Director |
Jul 1, 2022 | |
| Toni Manchester |
Corporate Director |
Jul 1, 2022 | |
| Rose Bradshaw |
Corporate Director |
Jul 1, 2022 | |
| Bobby Templton |
Corporate Director | Jul 1, 2026 | |
| James a Young |
Corporate Director |
Apr 8, 2019 | |
| Lisa M Medovich |
Corporate Officer |
Apr 8, 2019 | |
| W-2 Managing Employee |
Apr 8, 2019 | ||
| Brian P Bowers |
Corporate Director |
Apr 8, 2019 | |
| Sid Peterson Memorial Hospital |
5% Or Greater Direct Ownership Interest | Jan 1, 1990 | |
| Operational/Managerial Control | Jan 1, 1990 | ||
| Joseph Thomas Piszczor |
Corporate Officer |
Jul 14, 2020 | |
| W-2 Managing Employee | Jul 14, 2020 | ||
| Jeremy Walther |
Corporate Director |
Jul 1, 2024 | |
| Kendall Davison |
Corporate Director |
Jul 1, 2023 | |
| Johnathan W McDonald |
Corporate Officer |
May 27, 2025 | |
| W-2 Managing Employee |
May 27, 2025 | ||
| Christopher Ballesteros |
W-2 Managing Employee |
Jun 18, 2020 | |
| Thomas Houdeshell |
Corporate Director |
Jul 1, 2020 | |
| Kristen McAlexander |
Corporate Director |
Jul 1, 2023 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Peterson Regional Medical Center |
Hospital | Operational/Managerial Control | Jan 1, 1990 |
| Peterson Home Care |
Home health agency | Operational/Managerial Control | Feb 13, 2007 |
| Peterson Hospice |
Hospice | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Apr 26, 2007 Apr 26, 2007 |
| Peterson Community Care Clinic RHC |
Rural health clinic | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Jan 1, 1990 Jan 1, 1990 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Kerrville Physicians Ce
Locations
250 Cully Dr
Kerrville, TX 78028
Phone (830) 258-6300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | |||
| Rural Acute Care Hospital | 282NR1301X | 000406 | TX | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 127294003 | Medicaid | TX | |
| HH0439 | Other | TX | BLUE CROSS BLUE SHIELD |
Other names
- PETERSON REGIONAL MEDICAL CENTER
Other providers in Kerrville, TX
- Jon Dante Sibert
- Sid Peterson Memorial Hospital
- Sid Peterson Memorial Hospital
- Sid Peterson Memorial Hospital
- Sid Peterson Memorial Hospital
- Sid Peterson Memorial Hospital
- Sylvia Sieker
- Christine Faye Siftar
- John B. Silman
- Margaret Holman Simank
All providers in Kerrville, TX · Rural Acute Care Hospital in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.