NPIMap

Organization Active NPI

Ebd Bemc Burleson, LLC

Doing business as Baylor Scott & White Emergency Hospital Grand Prairie

  • General Acute Care Hospital
  • Grand Prairie, TX
National Provider Identifier
1831629526
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
EBD BEMC BURLESON, LLC
Doing business as
Baylor Scott & White Emergency Hospital Grand Prairie
Practice address
3095 Kingswood Blvd
Suite 100
Grand Prairie, TX 75052
Phone
(713) 637-1146
NPI assigned
Jun 14, 2017
Last updated
May 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Authorized official

Name
Tina Johnson
Title
Sr Provider Enrollment Coordinator
Phone
(713) 929-2076

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU
General Acute Care Hospital 282N00000X NU Primary

Addresses

Primary practice location

3095 Kingswood Blvd
Suite 100
Grand Prairie, TX 75052

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
348928801MedicaidTX
67-0107OtherTXMEDICARE

Other names 1

  • Baylor Scott & White Emergency Hospital Grand Prairie Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140714000550 TX Part A Provider - Hospital 5193940849 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Burleson, TX; Grand Prairie, TX; Mansfield, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831629526. Details of each certification follow.

Hospital certification: CCN 670107

Legal name
EBD BEMC BURLESON, LLC
Doing business as
BAYLOR SCOTT & WHITE EMERGENCY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Mar 19, 2015
Last certification
Mar 19, 2015
Beds
16
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
May 9, 2014 in TX
Enrollment address
12500 South Fwy
Ste 100
Burleson, TX 76028-7128
Other Hospital Practice Location
Hospital subgroups
Acute care

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
Baylor Scott and White Emergency HospitalCCN 670107 · All quality measures
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Ebd Bemc Burleson LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Vanessa Smith Individual Corporate OfficerPresident Nov 9, 2022
W-2 Managing Employee Nov 9, 2022
Emerus Group Holdings LP Organization, New York, NY Holding company 5% Or Greater Indirect Ownership Interest Sep 1, 2015 49%
Ebd JV, LLP Organization, The Woodlands, TX For-profit 5% Or Greater Indirect Ownership Interest Nov 14, 2013 49%
Victor Schmerbeck Individual W-2 Managing Employee Feb 15, 2020
John E Buck Individual 5% Or Greater Indirect Ownership Interest Nov 14, 2013 5.58%
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 Nov 14, 2013 5.58%
Jaba Interest LLC Organization, The Woodlands, TX LLC 5% Or Greater Indirect Ownership Interest Oct 16, 2014 5.17%
Thanh Tran Individual Corporate OfficerSecretary Nov 9, 2022
W-2 Managing Employee Nov 9, 2022
Emerus Holdings, Inc. Organization, The Woodlands, TX For-profit 5% Or Greater Indirect Ownership Interest Nov 14, 2013 49%
Welsh Carson Anderson & Stowe XII, LP Organization, New York, NY 5% Or Greater Indirect Ownership Interest Sep 1, 2015 19.37%
Baylor University Medical Center Organization, Dallas, TX 5% Or Greater Indirect Ownership Interest Nov 14, 2013 51%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 46

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

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1497398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1831629526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8686 NEW TRAILS DR STE 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": "3095 KINGSWOOD BLVD",
            "address_2": "SUITE 100",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "75052",
            "telephone_number": "713-637-1146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBD BEMC BURLESON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-14",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "SR PROVIDER ENROLLMENT COORDINATOR",
        "authorized_official_telephone_number": "713-929-2076"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "348928801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "67-0107",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baylor Scott & White Emergency Hospital Grand Prairie",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Prairie, TX

Sources for this page

Verify at the official NPI Registry.