NPIMap

Organization Active NPI

Fairfield Hospital District

Doing business as Leon Health Clinic

  • Rural Health Clinic/Center
  • Buffalo, TX
National Provider Identifier
1831782614
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAIRFIELD HOSPITAL DISTRICT
Doing business as
Leon Health Clinic
Practice address
144 Humphreys St
Buffalo, TX 75831-7555
Phone
(903) 389-2181
Fax
(903) 389-0906
NPI assigned
Feb 12, 2021
Last updated
Jan 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2023

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

Authorized official

Name
John M Yeary
Title
Ceo
Phone
(903) 389-2121

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary
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 1

  • Leon Health Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831782614. Details of each certification follow.

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
OtherNon-profit
Enrollment address
144 Humphreys St
Buffalo, TX 75831-7555
Related CCNs
450658

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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
45D2215575Leon Health Clinic144 Humphreys, Buffalo, TX 75831Certificate of waiverMar 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Fairfield Hospital District3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

734 W Commerce St
Ste C
Fairfield, TX 75840
Phone (903) 389-2121

604 Main St
Teague, TX 75860
Phone (903) 389-2181

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
Brent Moore Individual Corporate DirectorBoard Member Jan 1, 2017
George M Robinson Individual Corporate DirectorPresident of Board of Directors Jan 1, 2017
Danny Wren Individual Corporate DirectorBoard Director Aug 1, 2021
Carman R Mannen Individual Corporate DirectorBoard Member May 1, 2018
Community Hospital Consulting, Inc Organization, Plano, TX Corporation, Non-profit Operational/Managerial Control Jan 1, 2017
Lisa L Tate Individual Corporate DirectorBoard Memeber Jun 1, 2020
Fairfield Hospital District Organization, Fairfield, TX 5% Or Greater Direct Ownership Interest Jan 1, 2017 100%
Vance Oglesbee Individual Corporate DirectorBoard Member Feb 17, 2017
David L Lott Individual Corporate DirectorBoard Member Jan 1, 2017
Melissa Louise Wilson Individual Contracted Managing EmployeeCeo Aug 12, 2024
Corporate OfficerCeo Aug 12, 2024
Jennifer Azua Individual Corporate DirectorCfo/DO Jun 1, 2023
Margaret Nicole Hagen Individual Corporate OfficerChief Nursing Officer May 1, 2017

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Freestone Medical CenterFairfield, TX, CCN 450658 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2017
Freestone Medical CenterFairfield, TX, CCN 45U658 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2017
Freestone Health ClinicFairfield, TX, CCN 458502 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2017

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1613088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674691200000",
    "number": "1831782614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "734 W COMMERCE ST",
            "city": "FAIRFIELD",
            "state": "TX",
            "postal_code": "758401428",
            "telephone_number": "903-389-2181",
            "fax_number": "903-389-0906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 HUMPHREYS ST",
            "city": "BUFFALO",
            "state": "TX",
            "postal_code": "758317555",
            "telephone_number": "903-389-2181",
            "fax_number": "903-389-0906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFIELD HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-12",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A",
        "authorized_official_last_name": "YEARY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "903-389-2121"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Leon Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Leon Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buffalo, TX

Sources for this page

Verify at the official NPI Registry.