Active NPI
Waco Bluebonnet Holdings, Inc.
Doing business as Bluebonnet Health Services
- Community Based Hospice Care Agency
- Waco, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- License
- 010207
- Legal business name
- WACO BLUEBONNET HOLDINGS, INC.
- Doing business as
- Bluebonnet Health Services
- Practice address
- 307 Londonderry
Waco, TX 76712-7915 - Phone
- (254) 751-1790
- Fax
- (254) 751-7295
- NPI assigned
- Dec 14, 2006
- Last updated
- Aug 23, 2017
- Organization subpart
- Yes
- Parent organization
- AMC HEALTHCARE HOLDINGS, INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Brent D McKenzie
- Title
- Ceo
- Phone
- (254) 772-5577
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 010207 | TX | Primary |
Addresses
Primary practice location
307 Londonderry
Waco, TX 76712-7915
Mailing address
307 Londonderry Dr
Waco, TX 76712
Phone (254) 751-1790
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001014534 | Medicaid | TX |
Other names 1
- Bluebonnet Health Services
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100929000718 | TX | Part A Provider - Hospice | 1153447909 | Practice locations: Waco, TX; Tomball, TX; Bryan, TX; Round Rock, TX |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1902968464. Details of each certification follow.
Hospice certification: CCN 671532
- Legal name
- WACO BLUEBONNET HOLDINGS, INC.
- Doing business as
- BLUEBONNET HEALTH SERVICES
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- May 17, 2006
- Last certification
- Nov 5, 2020
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation
- Enrollment address
- 307 Londonderry Dr
Waco, TX 76712-7915
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Bluebonnet Health Services of Waco
- Home Health Agency
- Waco, TX
- NPI 1629136742
1153447909
-
dba Bluebonnet Health Services Supportive Care
- Nurse Practitioner
- Waco, TX
- NPI 1760282289
1153447909
Care Compare: Hospice
Medicare Care Compare- Listed as
- Bluebonnet Health Services
- Ownership
- For-Profit
- Certified
- May 17, 2006
- Medicare certification status
- Active
National Provider Directory
National Provider Directory- Tax ID family
- Blue Bonnet Hospice Home Care Inc
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Bluebonnet Health Services of Waco
- Home Health Agency
- Waco, TX
- NPI 1629136742
-
dba Bluebonnet Health Services Supportive Care
- Nurse Practitioner
- Waco, TX
- NPI 1760282289
Locations
1105 Wooded Acres Dr
Ste 260
Waco, TX 76710
Phone (254) 751-0798
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Holley Walsh | 5% Or Greater Indirect Ownership Interest | Jan 1, 2025 | 5% |
| Brent McKenzie | Corporate Officer | Feb 9, 2023 | |
| Corporate Director | Dec 1, 2015 | ||
| W-2 Managing Employee | Feb 1, 2023 | ||
| Operational/Managerial Control | Dec 1, 2015 | ||
| Brent Wilson | 5% Or Greater Indirect Ownership Interest | Jan 1, 2025 | 29.97% |
| Corporate Officer | Feb 9, 2023 | ||
| Corporate Director | Feb 21, 2022 | ||
| Ryan Gibson | 5% Or Greater Indirect Ownership Interest | Jan 1, 2025 | 6% |
| Corporate Director | Feb 21, 2022 | ||
| Mike Dunham | 5% Or Greater Indirect Ownership Interest | Jan 1, 2025 | 13.68% |
| Corporate Director | Feb 21, 2022 | ||
| Jeffery C Bates | Contracted Managing Employee | Sep 6, 2019 | |
| Michael Hillman | 5% Or Greater Indirect Ownership Interest | Jan 1, 2025 | 29.97% |
| Corporate Officer | Feb 9, 2023 | ||
| Corporate Director | Feb 21, 2022 | ||
| Floyd C Watson | Contracted Managing Employee | Aug 16, 2017 | |
| Adam David Flowers | Contracted Managing Employee | Jun 2, 2021 | |
| Mark Walsh | 5% Or Greater Indirect Ownership Interest | Jan 1, 2025 | 5% |
| Mildus LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2025 | 13.68% |
| AMC Healthcare Holdings Inc | 5% Or Greater Direct Ownership Interest | Oct 25, 2013 | 100% |
Owners & managing parties with NPI records 3
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Emergency Medicine Physician
- Gatesville, TX
- NPI 1134215643
Contracted Managing Employee
-
- Family Medicine Physician
- Woodway, TX
- NPI 1053443788
Contracted Managing Employee
-
- Family Medicine Physician
- McGregor, TX
- NPI 1447268164
Contracted Managing Employee
Facilities with the same owner 1
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Bluebonnet Health Services of Waco
- Home Health Agency
- Waco, TX
- NPI 1629136742
AMC Healthcare Holdings Inc, Mildus LLC
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Clinical Psychologist
- Waco, TX
- NPI 1295777134
Affiliated clinicians 11
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Internal Medicine) Physician
- Houston, TX
- NPI 1932314846
Hospice
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166054400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1503446400000",
"number": "1902968464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "307 LONDONDERRY DR",
"city": "WACO",
"state": "TX",
"postal_code": "76712",
"telephone_number": "254-751-1790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 LONDONDERRY",
"city": "WACO",
"state": "TX",
"postal_code": "767127915",
"telephone_number": "254-751-1790",
"fax_number": "254-751-7295"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WACO BLUEBONNET HOLDINGS, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "AMC HEALTHCARE HOLDINGS, INC",
"enumeration_date": "2006-12-14",
"last_updated": "2017-08-23",
"status": "A",
"authorized_official_last_name": "MCKENZIE",
"authorized_official_first_name": "BRENT",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "254-772-5577"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "TX",
"license": "010207",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001014534",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Bluebonnet Health Services",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Waco, TX
- Waco Ambulatory Surgery Center, LP (Waco Cardiology Cath Lab & Surgery Center)
- Waco Bariatric Surgeons
- Waco Birth Center & Clinic
- Waco Bluebonnet Holdings, Inc. (Bluebonnet Health Services of Waco)
- Waco Bluebonnet Holdings, Inc. (Bluebonnet Health Services Supportive Care)
- Waco Bone & Joint Clinic, P.a.
- Waco Cardiology Associates
- Waco Center for Oral & Maxillofacial Surgery PLLC
- Waco Center for Women's Health, P.a.
- Waco Dental and Orthodontics, PLLC (Rodeo Dental and Orthodontics)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.