NPIMap

Organization Active NPI

Jackson County Hospital District

Doing business as Jackson Medical Clinic of Edna

  • Rural Health Clinic/Center
  • Edna, TX
National Provider Identifier
1992748693
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JACKSON COUNTY HOSPITAL DISTRICT
Doing business as
Jackson Medical Clinic of Edna
Practice address
1013A South Wells Street
Edna, TX 77957-4045
Phone
(361) 782-3560
Fax
(361) 782-5627
NPI assigned
Jun 13, 2006
Last updated
Apr 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

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

Authorized official

Name
Lance Harrison Smiga
Title
Administrator/Cfo
Phone
(361) 782-7800

Specialties & licenses 1

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

Addresses

Primary practice location

1013A South Wells Street
Edna, TX 77957-4045

Mailing address

1013 S Wells Street
Edna, TX 77957-4098
Phone (361) 782-7800

Other names 1

  • Jackson Medical Clinic of Edna Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040601000224 TX Part B Supplier - Clinic/Group Practice 2365423795 Receives reassigned benefits from 99 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Edna, TX
O20100521000120 TX Part A Provider - Rural Health Clinic 2365423795 Practice locations: Edna, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992748693. Details of each certification follow.

Rural health clinic certification: CCN 458736

Legal name
JACKSON COUNTY HOSPITAL DISTRICT
Doing business as
JACKSON COUNTY MEDICAL CLINIC OF EDNA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 20, 1997
Last certification
Jun 28, 2024
Ownership / control type
Non-profit – church related
Organization structure
OtherProprietary
Incorporated
Jan 1, 2005 in TX
Enrollment address
1013A S Wells St
Edna, TX 77957-4045
Related CCNs
451363

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 2

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

National Provider Directory

National Provider Directory
Tax ID family
Edna Family Practice12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Jackson County Hospital District Organization, Edna, TX 5% Or Greater Direct Ownership Interest Jan 1, 2005 100%
Lance Smiga Individual Corporate OfficerCfo Jul 1, 2012 100%
W-2 Managing EmployeeCfo Jul 1, 2012 100%
Paula Gabrysch Individual Corporate DirectorSupervisor Jan 1, 2010 100%
W-2 Managing EmployeeSupervisor Jan 1, 2010 100%

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Jackson Healthcare CenterEdna, TX, CCN 451363 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2005
Jackson Healthcare CenterEdna, TX, CCN 45Z363 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 2005
Jackson County Home HealthEdna, TX, CCN 677103 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 31, 2011
Oct 31, 2011
Jackson County Medical Clinic of GanadoGanado, TX, CCN 673495 Rural health clinic Operational/Managerial Control Oct 1, 2025

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

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

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745798400000",
    "number": "1992748693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 S WELLS STREET",
            "city": "EDNA",
            "state": "TX",
            "postal_code": "779574098",
            "telephone_number": "361-782-7800",
            "fax_number": "361-782-7495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013A SOUTH WELLS STREET",
            "city": "EDNA",
            "state": "TX",
            "postal_code": "779574045",
            "telephone_number": "361-782-3560",
            "fax_number": "361-782-5627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A",
        "authorized_official_last_name": "SMIGA",
        "authorized_official_first_name": "LANCE",
        "authorized_official_middle_name": "HARRISON",
        "authorized_official_title_or_position": "ADMINISTRATOR/CFO",
        "authorized_official_telephone_number": "361-782-7800"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Medical Clinic of Edna",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jackson Medical Clinic of Edna",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edna, TX

Sources for this page

Verify at the official NPI Registry.