NPIMap

Organization Active NPI

Hometown Healthcare LLC

  • Rural Health Clinic/Center
  • Cotulla, TX
National Provider Identifier
1881911030
Registry record updated Feb 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
PA04256 Issued in TX
Legal business name
HOMETOWN HEALTHCARE LLC
Practice address
408 N Giraud
Cotulla, TX 78014-3113
Phone
(830) 879-2279
Fax
(830) 879-2235
NPI assigned
Apr 28, 2010
Last updated
Feb 20, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2017

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

Authorized official

Name
Mr. Will D Thompson, PA-CNPI 1659310175
Title
President
Phone
(830) 879-2279

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X PA04256 TX Primary

Addresses

Primary practice location

408 N Giraud
Cotulla, TX 78014-3113

Mailing address

PO Box 2070
Orange Grove, TX 78372-2070
Phone (830) 879-2279

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100729000789 TX Part A Provider - Rural Health Clinic 2567595424 Practice locations: Cotulla, TX
O20171102002256 TX Part B Supplier - Clinic/Group Practice 8426247925 Receives reassigned benefits from 8 practitioners
3 other NPIs on this enrollment
Practice locations: Cotulla, TX; Pearsall, TX; Dilley, TX; Orange Grove, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881911030. Details of each certification follow.

Rural health clinic certification: CCN 458927

Legal name
HOMETOWN HEALTHCARE LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 7, 1996
Last certification
Jan 20, 2016
Ownership / control type
1B
Most recent change of ownership
Apr 19, 2010 (2 total)
Organization structure
LLCProprietary
Incorporated
Apr 19, 2010 in TX
Enrollment address
408 N Giraud
Cotulla, TX 78014-3113

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
45D2017994Hometown Healthcare LLC408 N Giraud, Cotulla, TX 78014Certificate of waiverDec 21, 2026

National Provider Directory

National Provider Directory

Locations

101 S Eugenia St
Orange Grove, TX 78372
Phone (361) 382-2024

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Will D Thompson Individual 5% Or Greater Direct Ownership Interest Dec 31, 2012 100%
5% Or Greater Mortgage Interest Dec 31, 2012 100%
5% Or Greater Security Interest Dec 31, 2012 100%
Corporate OfficerPresident Dec 31, 2012 100%
Operational/Managerial ControlPresident Dec 31, 2012 100%

Owners & managing parties with NPI records 1

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

  • Will Donn Thompson, MPAS, PA-C
    • Physician Assistant
    • Orange Grove, TX
    • NPI 1659310175

    5% Or Greater Direct Ownership Interest, 5% Or Greater Mortgage Interest, 5% Or Greater Security Interest, Corporate Officer, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1272412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1881911030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2070",
            "city": "ORANGE GROVE",
            "state": "TX",
            "postal_code": "783722070",
            "telephone_number": "830-879-2279",
            "fax_number": "830-879-2235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 N GIRAUD",
            "city": "COTULLA",
            "state": "TX",
            "postal_code": "780143113",
            "telephone_number": "830-879-2279",
            "fax_number": "830-879-2235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMETOWN HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-28",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "WILL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "830-879-2279",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TX",
            "license": "PA04256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cotulla, TX

Sources for this page

Verify at the official NPI Registry.