NPIMap

Organization Active NPI

Lavaca Hospital District

Doing business as Lavaca Medical Center

  • Critical Access Hospital
  • Hallettsville, TX
National Provider Identifier
1992767511
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
LAVACA HOSPITAL DISTRICT
Doing business as
Lavaca Medical Center
Practice address
1400 N Texana
Hallettsville, TX 77964-2021
Phone
(361) 798-3671
Fax
(361) 798-3128
NPI assigned
Apr 6, 2006
Last updated
Oct 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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

Authorized official

Name
Jack S Bowen
Title
Administrator
Phone
(361) 798-3671

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X Primary

Addresses

Primary practice location

1400 N Texana
Hallettsville, TX 77964-2021

Mailing address

1400 N Texana
Hallettsville, TX 77964-2021
Phone (361) 798-3671

Other identifiers 1

IdentifierTypeStateIssuer
135233809MedicaidTX

Other names 1

  • Lavaca Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000500 TX Part A Provider - Critical Access Hospital 1153211750 Receives reassigned benefits from 38 practitioners
Practice locations: Hallettsville, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992767511. Details of each certification follow.

Hospital certification: CCN 451376

Legal name
LAVACA HOSPITAL DISTRICT
Doing business as
LAVACA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 29, 2005
Last certification
Sep 19, 2023
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Enrollment address
1400 N Texana St
Hallettsville, TX 77964-2021
Hospital Swing-Bed Unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
Lavaca Medical CenterCCN 451376 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Lavaca Medicla Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Tracy Green Individual Corporate Director Apr 27, 2015
W-2 Managing Employee Apr 27, 2015
Jack Bowen Individual Corporate Officer Jul 22, 2015
W-2 Managing Employee Jul 22, 2015

Practitioners & affiliated clinicians

Practitioners 40

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 40

Affiliated clinicians 134

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

View all 134

NPI Registry JSON

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1992767511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 N TEXANA",
            "city": "HALLETTSVILLE",
            "state": "TX",
            "postal_code": "779642021",
            "telephone_number": "361-798-3671",
            "fax_number": "361-798-3128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 N TEXANA",
            "city": "HALLETTSVILLE",
            "state": "TX",
            "postal_code": "779642021",
            "telephone_number": "361-798-3671",
            "fax_number": "361-798-3128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAVACA HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-06",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "BOWEN",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "361-798-3671"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135233809",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lavaca Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hallettsville, TX

Sources for this page

Verify at the official NPI Registry.