NPIMap

Organization Active NPI

Dewitt Medical District

Doing business as Goliad Family Practice

  • Rural Health Clinic/Center
  • Goliad, TX
National Provider Identifier
1831567122
Registry record updated Aug 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DEWITT MEDICAL DISTRICT
Doing business as
Goliad Family Practice
Practice address
139 W Franklin St
Goliad, TX 77963-4281
Phone
(361) 645-8235
Fax
(361) 645-3282
NPI assigned
Sep 3, 2015
Last updated
Aug 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2022

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

Authorized official

Name
Alma Alexander
Title
Cfo
Phone
(361) 275-6191

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

139 W Franklin St
Goliad, TX 77963-4281

Mailing address

139 W Franklin St
Goliad, TX 77963-4281
Phone (361) 645-8235

Other identifiers 3

IdentifierTypeStateIssuer
363141801OtherTXMEDICAID RHC
357774401MedicaidTX
363141802OtherTXTHSTEPS RHC MEDICAID

Other names 1

  • GOLIAD FAMILY PRACTICE Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031202000088 TX Part B Supplier - Clinic/Group Practice 3072421395 Receives reassigned benefits from 77 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Yorktown, TX; Yoakum, TX; Victoria, TX; Schulenburg, TX; Goliad, TX; Kenedy, TX; Cuero, TX
O20151217002293 TX Part A Provider - Rural Health Clinic 3072421395 Practice locations: Goliad, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831567122. Details of each certification follow.

Rural health clinic certification: CCN 673433

Legal name
DEWITT MEDICAL DISTRICT
Doing business as
GOLIAD FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 1, 2015
Last certification
Jan 30, 2024
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
139 W Franklin St
Goliad, TX 77963-4281
Related CCNs
450597

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

Other NPIs with the same Medicare PAC ID 20

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

View all 20

Other NPIs on the same Medicare enrollment 6

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

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
45D0498869Dewitt Medical District139 W Franklin St, Goliad, TX 77963Certificate of waiverJan 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Cuero Community Hosp HH28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

Locations

139 W Franklin St
Goliad, TX 77963
Phone (361) 645-8235

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Anna Faye Sheppard Individual Corporate DirectorVice Chairman May 21, 2019
Charles Papacek Individual Corporate DirectorSecretary May 27, 2014
John H Frels Individual Corporate DirectorDirector Sep 1, 2015
Alma Alexander Individual Contracted Managing EmployeeOfficer May 27, 2020
Corporate OfficerCfo May 27, 2020
Cody a Walthall Individual W-2 Managing EmployeeMedical Director Aug 15, 2023
Cynthia Sheppard Individual Corporate Director May 27, 2014
Richard Wheeler Individual Corporate DirectorChairman May 27, 2014

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 14

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

FacilityTypeRoleSince
Dewitt Medical DistrictCuero, TX, CCN 450597 Hospital Operational/Managerial Control Feb 1, 2001
Kingsville Nursing and Rehabilitation CenterKingsville, TX, CCN 675815 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Jan 1, 2015
Jan 1, 2015
Apr 2, 2025
Windsor Nursing and Rehabilitation Center of Corpus ChristiCorpus Christi, TX, CCN 676321 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Jan 1, 2015
Jan 1, 2015
Apr 3, 2025
Corpus Christi Nursing and Rehabilitation CenterCorpus Christi, TX, CCN 676107 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF
Direct Ownership Interest (100%)		 Jan 1, 2015
Jan 1, 2015
May 20, 2025
Jan 1, 2015
Pflugerville Nursing and Rehabilitation CenterPflugerville, TX, CCN 676245 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)
Adp of the SNF		 Feb 18, 2015
Feb 28, 2015
Apr 3, 2025
Windsor CalallenCorpus Christi, TX, CCN 676391 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)
Adp of the SNF		 Feb 1, 2016
Feb 1, 2016
Apr 3, 2025
Legend Oaks Healthcare and Rehabilitation-West San AntonioSan Antonio, TX, CCN 676312 Skilled nursing facility 5% Or Greater Indirect Ownership Interest (100%) Apr 1, 2017
Legend Oaks Healthcare and Rehabilitation-San AntonioSan Antonio, TX, CCN 676113 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Sonterra Health CenterSan Antonio, TX, CCN 676158 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Parklane West Healthcare CenterSan Antonio, TX, CCN 675509 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
Yorktown Nursing and Rehabilitation CenterYorktown, TX, CCN 675071 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
Lampassas Nursing and Rehabilitation CenterLampasas, TX, CCN 455513 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
Diversicare of LulingLuling, TX, CCN 675075 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
Yorktown Medical ClinicYorktown, TX, CCN 673451 Rural health clinic Operational/Managerial Control Jul 22, 2013

Owned or controlled facilities with NPI records 14

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

  • Dewitt Medical District

    dba Yorktown Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Yorktown, TX
    • NPI 1255372488

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Dewitt Medical District

    dba Lampasas Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Lampasas, TX
    • NPI 1346281573

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Dewitt Medical District

    dba Diversicare of Luling

    • Skilled Nursing Facility
    • Luling, TX
    • NPI 1396789491

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Dewitt Medical District

    dba Windsor Nursing and Rehabilitation Center of Corpus Christi

    • Skilled Nursing Facility
    • Corpus Christi, TX
    • NPI 1407127384

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

    CMS ownership
  • Dewitt Medical District

    dba Cuero Regional Hospital

    • Rural Acute Care Hospital
    • Cuero, TX
    • NPI 1437148020

    Operational/Managerial Control

    CMS ownership
  • Dewitt Medical District

    dba Yorktown Medical Clinic

    • Rural Health Clinic/Center
    • Yorktown, TX
    • NPI 1821422551

    Operational/Managerial Control

    CMS ownership
  • Dewitt Medical District

    dba Kingsville Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Kingsville, TX
    • NPI 1841254174

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

    CMS ownership
  • Dewitt Medical District

    dba Corpus Christi Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Corpus Christi, TX
    • NPI 1861442469

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Dewitt Medical District

    dba Windsor Calallen

    • Skilled Nursing Facility
    • Corpus Christi, TX
    • NPI 1932596343

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

    CMS ownership
  • Dewitt Medical District

    dba Pflugerville Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Pflugerville, TX
    • NPI 1962735175

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

    CMS ownership
  • Guadalupe County Hospital Board

    dba Parklane West Healthcare Center

    • Skilled Nursing Facility
    • San Antonio, TX
    • NPI 1235671629

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Guadalupe County Hospital Board

    dba Legend Oaks Healthcare and Rehabilitation Center - San Antonio

    • Skilled Nursing Facility
    • San Antonio, TX
    • NPI 1710348685

    5% Or Greater Direct Ownership Interest

    CMS ownership
View all 14

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1441238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660780800000",
    "number": "1831567122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 W FRANKLIN ST",
            "city": "GOLIAD",
            "state": "TX",
            "postal_code": "779634281",
            "telephone_number": "361-645-8235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 W FRANKLIN ST",
            "city": "GOLIAD",
            "state": "TX",
            "postal_code": "779634281",
            "telephone_number": "361-645-8235",
            "fax_number": "361-645-3282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEWITT MEDICAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-03",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "ALMA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "361-275-6191"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID RHC",
            "identifier": "363141801",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "357774401",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THSTEPS RHC MEDICAID",
            "identifier": "363141802",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GOLIAD FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GOLIAD FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Goliad, TX

Sources for this page

Verify at the official NPI Registry.