NPIMap

De Craig Ranch, LLC

Organization Active NPI General Acute Care Hospital · Las Vegas, NV

NPI 1922542968 · NPPES record last updated Oct 23, 2018

Key facts

NPI
1922542968
Entity type
Organization (NPI type 2)
Primary specialty
General Acute Care Hospital 282N00000X
Legal business name
DE CRAIG RANCH, LLC
Practice address
4855 Blue Diamond Rd
Las Vegas, NV 89139
Phone
(713) 637-1146
Fax
(281) 298-5311
NPI assigned
Dec 9, 2016
Organization subpart
Yes
Parent organization (as reported)
DE CRAIG RANCH, LLC

Authorized official

Name
John Buck
Title
President
Phone
(713) 637-1004

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Other NPIs on the same Medicare enrollment 4

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

Corporate family (same tax ID) 4

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

Practitioners 89

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 89

Affiliated clinicians 93

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 93

Medicare Care Compare: Hospital

Listed as
Saint Rose Dominican Hospitals - North Las Vegas CCN 290058
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D2129184Dignity St Rose - Blue Diamond
4855 Blue Diamond Rd, Las Vegas, NV 89139		AccreditationMar 29, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NV

Hospital certification: CCN 290058

Legal name
DE CRAIG RANCH LLC
Doing business as
DIGNITY HEALTH ST ROSE DOMINICAN NORTH LAS VEGAS CAMPUS
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Oct 23, 2017
Last certification
Oct 23, 2017
Beds
32
Ownership / control type
Private (for profit)
Organization structure
LLC · Proprietary
Incorporated
Feb 11, 2016 in NV
Enrollment address
1550 W Craig Rd
Ste 100
North Las Vegas, NV 89032-0329
Other Hospital Practice Location
Hospital subgroups
Acute care

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Homer D Kirby
Individual 		5% Or Greater Indirect Ownership Interest
In-Direct Owner		 May 11, 2012 9%
Vanessa Smith
Individual 		Corporate Director
Board Member		 Apr 17, 2020
W-2 Managing Employee Apr 17, 2020
Emerus Group Holdings LP
Organization · New York, NY
Holding company 		5% Or Greater Indirect Ownership Interest Sep 1, 2015 49%
Dignity Health
Organization · The Woodlands, TX
Corporation 		5% Or Greater Indirect Ownership Interest May 5, 2016 51%
Victor Schmerbeck
Individual 		Corporate Officer
President		 Feb 15, 2020
W-2 Managing Employee
Board Member		 Feb 15, 2020
John E Buck
Individual 		Corporate Officer
Secretary		 Jun 16, 2016
W-2 Managing Employee May 16, 2016
Emerus Intermediate Holdings Inc
Organization · New York, NY
Corporation, Holding company 		5% Or Greater Indirect Ownership Interest Sep 1, 2015 49%
Toby R Hamilton
Individual 		5% Or Greater Indirect Ownership Interest Sep 1, 2015 5.92%
Jaba Interest LLC
Organization · The Woodlands, TX
LLC 		5% Or Greater Indirect Ownership Interest Oct 16, 2015 10%
Hemant Vankawala
Individual 		5% Or Greater Indirect Ownership Interest
In-Direct Owner		 May 11, 2012 7%
Linda Tautz
Individual 		Corporate Director
Board Member		 Jun 2, 2021
Brian D Kleven
Individual 		Corporate Officer
Secretary		 Aug 2, 2022
Corporate Director
Board Member		 Dec 12, 2019
Emerus Investment Company V, LLC
Organization · The Woodlands, TX
Corporation 		5% Or Greater Indirect Ownership Interest May 4, 2016 49%
Emerus Holdings, Inc.
Organization · The Woodlands, TX
Corporation, For-profit 		5% Or Greater Indirect Ownership Interest Sep 1, 2015 49%
Welsh Carson Anderson & Stowe XII, LP
Organization · New York, NY 		5% Or Greater Indirect Ownership Interest Sep 1, 2015 19.37%
De JV LLC
Organization · The Woodlands, TX
For-profit 		5% Or Greater Direct Ownership Interest May 5, 2016 100%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20170818002615 NV Part a Provider - Hospital 6002183563 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Las Vegas, NV; North Las Vegas, NV

National Provider Directory

Tax ID family
De Craig Ranch LLC (5 organizations share this tax ID)
Part of
De Craig Ranch LLC

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Yes

Addresses

Primary practice location

4855 Blue Diamond Rd
Las Vegas, NV 89139

Mailing address

8686 New Trails Dr
Suite 100
The Woodlands, TX 77381-1176
Phone (713) 637-1146

Other identifiers

IdentifierTypeStateIssuer
1922542968MedicaidNV
29-0058OtherMEDICARE

Other names

  • Dignity Health-St. Rose Dominican Blue Diamond Campus Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 23, 2018.

{
    "created_epoch": "1481241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540252800000",
    "number": "1922542968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8686 NEW TRAILS DR",
            "address_2": "SUITE 100",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773811176",
            "telephone_number": "713-637-1146",
            "fax_number": "281-298-5311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4855 BLUE DIAMOND RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89139",
            "telephone_number": "713-637-1146",
            "fax_number": "281-298-5311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DE CRAIG RANCH, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DE CRAIG RANCH, LLC",
        "enumeration_date": "2016-12-09",
        "last_updated": "2018-10-23",
        "status": "A",
        "authorized_official_last_name": "BUCK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "713-637-1004"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922542968",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "29-0058",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dignity Health-St. Rose Dominican Blue Diamond Campus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

All providers in Las Vegas, NV · General Acute Care Hospital in Nevada

Sources for this page

Verify at the official NPI Registry.