Fairfield Hospital District
Organization Active NPI Rural Health Clinic/Center · Buffalo, TX
NPI 1831782614 · NPPES record last updated Jan 26, 2023
Key facts
- NPI
- 1831782614
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- FAIRFIELD HOSPITAL DISTRICT
- Practice address
- 144 Humphreys St
Buffalo, TX 75831-7555 - Phone
- (903) 389-2181
- Fax
- (903) 389-0906
- NPI assigned
- Feb 12, 2021
- Organization subpart
- No
Authorized official
- Name
- John M Yeary
- Title
- Ceo
- Phone
- (903) 389-2121
Owners & managing parties with NPI records 3
-
David Lott, MPT
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Related certifications (CCN) 1
Facilities with the same owner 3
Practitioners 25
-
Joseph E T Bales, M.D.
-
Joseph R Berger III, D.O.
-
Mark Ryan Boyle, MD
-
Wayne Morgan Bruner, M. D.
-
Steve Dang, DO
-
William Dodds, DO
-
Kayla Sierra Farmer, APRN, FNP-S
-
Stacy Ann Gallegos, FNP
-
Veronica Harris, FNP
-
Michael Jeffrey Jenks, M.D.
-
Jared Kennedy, M.D.
-
Katrina Logan, FNP-BC
-
Mark Waweru, M.D.
-
Darryl White, M.D.
-
Andrew Burnette, D.O.
-
Amy Lynne Brooks, MSN, APRN, FNP-C
-
Brett Allen Burnett, M.D.
-
James Michael Grissett, APRN, FNP-C
-
Meghan E Smith, M.D.
-
David Lott, MPT
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2215575 | Leon Health Clinic | Certificate of waiver | Mar 3, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Rural health clinic certification: CCN 678564
- Legal name
- FAIRFIELD HOSPITAL DISTRICT
- Doing business as
- LEON HEALTH CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 24, 2022
- Last certification
- Apr 3, 2025
- Ownership / control type
- Non-profit – church related
- Organization structure
- Other · Non-profit
- Enrollment address
- 144 Humphreys St
Buffalo, TX 75831-7555 - Related CCNs
- 450658
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Brent Moore |
Corporate Director |
Jan 1, 2017 | |
| George M Robinson |
Corporate Director |
Jan 1, 2017 | |
| Danny Wren |
Corporate Director |
Aug 1, 2021 | |
| Carman R Mannen |
Corporate Director |
May 1, 2018 | |
| Community Hospital Consulting, Inc |
Operational/Managerial Control | Jan 1, 2017 | |
| Lisa L Tate |
Corporate Director |
Jun 1, 2020 | |
| Fairfield Hospital District |
5% Or Greater Direct Ownership Interest | Jan 1, 2017 | 100% |
| Vance Oglesbee |
Corporate Director |
Feb 17, 2017 | |
| David L Lott |
Corporate Director |
Jan 1, 2017 | |
| Melissa Louise Wilson |
Contracted Managing Employee |
Aug 12, 2024 | |
| Corporate Officer |
Aug 12, 2024 | ||
| Jennifer Azua |
Corporate Director |
Jun 1, 2023 | |
| Margaret Nicole Hagen |
Corporate Officer |
May 1, 2017 |
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Freestone Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2017 |
| Freestone Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2017 |
| Freestone Health Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170206000615 | TX | Part B Supplier - Clinic/Group Practice | 6507149192 |
Receives reassigned benefits from 24 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Buffalo, TX; Fairfield, TX; Teague, TX |
| O20210426001627 | TX | Part a Provider - Rural Health Clinic | 6507149192 | Practice locations: Buffalo, TX |
National Provider Directory
- Tax ID family
- Fairfield Memorial HSP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| Medical Physician Assistant |
363AM0700X | |||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
144 Humphreys St
Buffalo, TX 75831-7555
Mailing address
734 W Commerce St
Fairfield, TX 75840-1428
Phone (903) 389-2181
Other names
- Leon Health Clinic
Other providers in Buffalo, TX
- Brookshire Brothers Inc
- Buffalo Family Practice PLLC
- Buffalo Vista Urgent Family Care, PLLC
- Copper Creek Nursing & Rehab, Inc
- Daniel Kayode Ezeji
- Kylan Leigh Ferguson
- Mona Jill Ferguson
- Andrena Pauline Glick
- Mikel David Gonzales
- Brittany Celeste Haritos
All providers in Buffalo, TX · Rural Health Clinic/Center in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2023. 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.