Pam Squared at Texarkana, LLC

Primary specialty

Long Term Care HospitalTaxonomy code 282E00000X

Legal business name

PAM SQUARED AT TEXARKANA, LLC

Doing business as

PAM Specialty Hospital of Texarkana South

Practice address

1000 Pine St
6TH Floor
Texarkana, TX 75501-5100

Phone

(903) 798-7600

NPI assigned

Sep 15, 2014

Last updated

Oct 20, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Anthony F. Misitano

Title

President

Phone

(717) 731-9660

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• PAM Specialty Hospital of Texarkana South Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942601547. Details of each certification follow.

• CCN 452061 Hospital · Active · Details

Hospital certification: CCN 452061

Legal name

PAM SQUARED AT TEXARKANA LLC

Doing business as

PAM SPECIALTY HOSPITAL OF TEXARKANA NORTH

Certification status

Active

Provider type (POS)

Hospital – Long-term

Participating since

Feb 1, 1999

Last certification

Jun 7, 2018

Beds

49

Ownership / control type

Private (for profit)

Most recent change of ownership

Nov 3, 2014 (1 total)

Organization structure

LLCProprietary

Incorporated

Aug 25, 2014 in PA

Enrollment address

2400 St Michael Dr 2ND Floor
Pam Specialty Hospital of Texarkana North
Texarkana, TX 75503-2374
Other Hospital Practice Location

Hospital subgroups

Long-term

Other NPIs on the same Medicare enrollment 1

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

• Pam Squared at Texarkana, LLC

  dba PAM Specialty Hospital of Texarkana North

  • Long Term Care Hospital
  • Texarkana, TX
  • NPI 1225439821

  O20141217000656

  Same enrollment

Listed as

Post Acute Medical Specialty Hospital of TexarkanaCCN 452061 · All quality measures

Ownership

For profit

Certified

Feb 1, 1999

Medicare certification status

ActiveFrom the Provider of Services file

Beds

49

All disclosed owners & managing parties 7

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

Affiliated clinicians 5

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

• Greggory N. Angier, MD

  • Surgery Physician
  • Texarkana, TX
  • NPI 1114094273

  Long-term care hospital

  Care Compare affiliation
• Dewitt Charles Fortenberry, MD

  • General Practice Physician
  • Texarkana, TX
  • NPI 1114960473

  Long-term care hospital

  Care Compare affiliation
• Carlos Luis Perez, MD

  • Pulmonary Disease Physician
  • Texarkana, TX
  • NPI 1598783870

  Long-term care hospital

  Care Compare affiliation
• Candace L Baird, APRN, FNP-C

  • Family Nurse Practitioner
  • Texarkana, AR
  • NPI 1720670474

  Long-term care hospital

  Care Compare affiliation
• Dennis Michael Blankenship, M.D.

  • Nephrology Physician
  • Texarkana, AR
  • NPI 1821086547

  Long-term care hospital

  Care Compare affiliation

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

{
    "created_epoch": "1410739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476921600000",
    "number": "1942601547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1828 GOOD HOPE RD",
            "address_2": "SUITE 102",
            "city": "ENOLA",
            "state": "PA",
            "postal_code": "170251233",
            "telephone_number": "717-731-9660",
            "fax_number": "717-731-9665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 PINE ST",
            "address_2": "6TH FLOOR",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755015100",
            "telephone_number": "903-798-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAM SQUARED AT TEXARKANA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-15",
        "last_updated": "2016-10-20",
        "status": "A",
        "authorized_official_last_name": "MISITANO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "717-731-9660",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "357622501",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200645170 B",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208485105",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "357622502",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PAM Specialty Hospital of Texarkana South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Palliative Connections of Texas Inc
• Pallicare Health, PLLC
• Pallicare Medical Services, PLLC
• Pallicare, Inc
• Pam Squared at Texarkana, LLC (PAM Specialty Hospital of Texarkana North)
• Pappas Medical Clinic PA
• Rosamma G Parangimalil, NP
• Mukti Parbhoo, MD
• Stephen R Parish, MD
• Colton Parker, HIS

• Long Term Care Hospital in Texarkana, TX
• Providers in Texarkana, TX by specialty
• Long Term Care Hospital in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; 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.

Verify at the official NPI Registry.