NPIMap

Organization Active NPI

Winnie Community Hospital, LLC

Doing business as Winnie Community Clinic

  • Rural Health Clinic/Center
  • Winnie, TX
National Provider Identifier
1891820569
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WINNIE COMMUNITY HOSPITAL, LLC
Doing business as
Winnie Community Clinic
Practice address
538 Broadway
Winnie, TX 77665-7600
Phone
(409) 296-6351
Fax
(409) 263-6386
NPI assigned
Feb 22, 2007
Last updated
Sep 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Authorized official

Name
Dr. Mohammed Danishmund
Title
Cfo
Phone
(409) 730-8054

Specialties & licenses 1

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

Addresses

Primary practice location

538 Broadway
Winnie, TX 77665-7600

Mailing address

538 Broadway
Winnie, TX 77665-7600
Phone (409) 296-6351

Other names 1

  • Winnie Community Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060828000231 TX Part A Provider - Rural Health Clinic 3375440894 1 other NPI on this enrollment
Practice locations: Winnie, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891820569. Details of each certification follow.

Rural health clinic certification: CCN 458874

Legal name
WINNIE COMMUNITY HOSPITAL LLC
Doing business as
WINNIE COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 19, 2006
Last certification
Jun 11, 2019
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Feb 2, 2001 in TX
Enrollment address
538 Broadway
Winnie, TX 77665-7600
Related CCNs
451328

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Winnie Comm Hosp LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

390 N 11th St
Beaumont, TX 77702
Phone (409) 981-5500

85 Interstate 10 N
Ste 111
Beaumont, TX 77707

2400 Highway 365
Nederland, TX 77627
Phone (409) 729-9200

3623 S Main St
Ste 109
Stafford, TX 77477
Phone (281) 969-7643

515 S Archie St
Ste 3
Vidor, TX 77662
Phone (409) 769-2295

403 S Magnolia St
Woodville, TX 75979
Phone (409) 283-2888

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Stephen Deatrick Individual Operational/Managerial ControlAdministrator Oct 15, 2019
M Israr Ahmad Individual 5% Or Greater Indirect Ownership Interest Jun 6, 2014 19.6%
Mohammad S Javed Individual 5% Or Greater Indirect Ownership Interest Jun 6, 2014 19.6%
Riceland Medical Holding Company LP Organization, Beaumont, TX 5% Or Greater Direct Ownership Interest Jun 6, 2014 99%
Muhammad Javed Individual 5% Or Greater Indirect Ownership Interest Jun 6, 2014 41.19%
Riceland Healthcare LP Organization, Beaumont, TX 5% Or Greater Indirect Ownership Interest Jun 6, 2014 98.01%
Mohammed Danishmund Individual Corporate OfficerChief Financial Officer Jun 6, 2014
Abdul Jabbar Individual 5% Or Greater Indirect Ownership Interest Jun 6, 2014 19.6%

Facilities with the same owner 2

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

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": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664409600000",
    "number": "1891820569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 BROADWAY",
            "city": "WINNIE",
            "state": "TX",
            "postal_code": "776657600",
            "telephone_number": "409-296-6351",
            "fax_number": "409-263-6386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "538 BROADWAY",
            "city": "WINNIE",
            "state": "TX",
            "postal_code": "776657600",
            "telephone_number": "409-296-6351",
            "fax_number": "409-263-6386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINNIE COMMUNITY HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A",
        "authorized_official_last_name": "DANISHMUND",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "409-730-8054",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Winnie Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Winnie Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winnie, TX

Sources for this page

Verify at the official NPI Registry.