NPIMap

Organization Active NPI

Pittsburg Hospital LLC

  • Internal Medicine Physician
  • Pittsburg, TX
National Provider Identifier
1942700331
Registry record updated Jul 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PITTSBURG HOSPITAL LLC
Practice address
2701 US Highway 271 N
Pittsburg, TX 75686-4289
Phone
(903) 946-5442
Fax
(903) 946-5258
NPI assigned
Feb 13, 2018
Last updated
Jul 29, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
AHS EAST TEXAS HEALTH SYSTEM, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 29, 2019

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

Authorized official

Name
Stephen C. Petrovich
Title
Evp
Phone
(615) 296-3000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

2701 US Highway 271 N
Pittsburg, TX 75686-4289

Mailing address

1 Burton Hills Blvd Ste 250
Nashville, TN 37215-6195
Phone (615) 296-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180604001525 TX Part B Supplier - Clinic/Group Practice 5597029272 Receives reassigned benefits from 19 practitioners
3 other NPIs on this enrollment
Practice locations: Mt Pleasant, TX; Pittsburg, TX

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.

National Provider Directory

National Provider Directory
Tax ID family
Pittsburg Hospital LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1518480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564358400000",
    "number": "1942700331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BURTON HILLS BLVD STE 250",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156195",
            "telephone_number": "615-296-3000",
            "fax_number": "615-296-6227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 US HIGHWAY 271 N",
            "city": "PITTSBURG",
            "state": "TX",
            "postal_code": "756864289",
            "telephone_number": "903-946-5442",
            "fax_number": "903-946-5258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PITTSBURG HOSPITAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AHS EAST TEXAS HEALTH SYSTEM, LLC",
        "enumeration_date": "2018-02-13",
        "last_updated": "2019-07-29",
        "status": "A",
        "authorized_official_last_name": "PETROVICH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "EVP",
        "authorized_official_telephone_number": "615-296-3000"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsburg, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.