Sid Peterson Memorial Hospital
Organization Active NPI Rehabilitation Hospital Unit · Kerrville, TX
NPI 1992796239 · NPPES record last updated Jul 27, 2022
Key facts
- NPI
- 1992796239
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rehabilitation Hospital Unit 273Y00000X
- License
- 000406 (TX)
- Legal business name
- SID PETERSON MEMORIAL HOSPITAL
- Practice address
- 551 Hill Country Dr
Kerrville, TX 78028-6085 - Phone
- (830) 896-4200
- Fax
- (830) 258-7678
- NPI assigned
- Nov 4, 2005
- Organization subpart
- No
Authorized official
- Name
- Ms. Lisa M Medovich, CPA
- Title
- Cfo
- Phone
- (830) 258-7632
Owners & managing parties with NPI records 6
-
Michael D. Ross, MD
-
James Alan Young, MD
Owned or controlled facilities with NPI records 4
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 5
Related certifications (CCN) 1
Facilities with the same owner 4
Practitioners 7
-
Vanessa R Cox, DNP, APRN, FNP-BC
-
Brittany Holder, FNP
-
Deepti Nagpal, AGCNS
-
Frank Pawlak, FNP-C
-
James Alan Young, MD
Affiliated clinicians 6
-
Kolby Rashelle Barton, FNP-C
-
Mirelle' Jeanne Foster, M.D.
-
Thomas Shaw, M.D.
-
Leatha Tampke, FNP
Medicare Care Compare: Inpatient rehabilitation facility
- Listed as
- Sid Peterson Memorial Hospital
- Ownership
- Non-profit
- Certified
- Jul 1, 2002
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Hospital certification: CCN 45T007
- Legal name
- SID PETERSON MEMORIAL HOSPITAL
- Doing business as
- PETERSON REGIONAL MEDICAL CENTER
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 13, 1989 in TX
- Enrollment address
- 551 Hill Country Dr
Kerrville, TX 78028-6085 - Hospital subgroups
- General, Acute care, Rehabilitation unit
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Gaye Avery |
Corporate Director |
Jul 1, 2024 | |
| Michael D Ross |
Corporate Director |
Jul 1, 2024 | |
| Norman Williams |
Corporate Director |
Jul 1, 2022 | |
| Toni Manchester |
Corporate Director |
Jul 1, 2022 | |
| Rose Bradshaw |
Corporate Director |
Jul 1, 2022 | |
| Bobby Templton |
Corporate Director | Jul 1, 2026 | |
| James a Young |
Corporate Director |
Apr 30, 2019 | |
| Lisa M Medovich |
Corporate Officer |
Apr 30, 2019 | |
| W-2 Managing Employee |
Apr 30, 2019 | ||
| Brian P Bowers |
Corporate Director |
Apr 30, 2019 | |
| Sid Peterson Memorial Hospital |
Operational/Managerial Control | Jan 1, 1990 | |
| Joseph Thomas Piszczor |
Corporate Officer |
Jul 14, 2020 | |
| W-2 Managing Employee | Jul 14, 2020 | ||
| Jeremy Walther |
Corporate Director |
Jul 1, 2024 | |
| Kendall Davison |
Corporate Director |
Jul 1, 2023 | |
| Johnathan W McDonald |
Corporate Officer |
May 27, 2025 | |
| W-2 Managing Employee |
May 27, 2025 | ||
| Christopher Ballesteros |
W-2 Managing Employee |
Apr 30, 2019 | |
| Thomas Houdeshell |
Corporate Director |
Jul 1, 2020 | |
| Kristen McAlexander |
Corporate Director |
Jul 1, 2023 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Peterson Community Care Clinic RHC |
Hospital | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Jan 1, 1990 Jan 1, 1990 |
| Peterson Home Care |
Home health agency | Operational/Managerial Control | Feb 13, 2007 |
| Peterson Hospice |
Hospice | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Apr 26, 2007 Apr 26, 2007 |
| Peterson Community Care Clinic RHC |
Rural health clinic | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Jan 1, 1990 Jan 1, 1990 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080804000036 | TX | Part a Provider - Hospital | 6002724887 | Practice locations: Kerrville, TX |
National Provider Directory
- Tax ID family
- Kerrville Physicians Ce
Locations
2090 Bandera Hwy
Kerrville, TX 78028
Phone (830) 257-9900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Hospital Unit | 273Y00000X | 000406 | TX | Yes |
Addresses
Primary practice location
551 Hill Country Dr
Kerrville, TX 78028-6085
Mailing address
551 Hill Country Dr
Kerrville, TX 78028-6085
Phone (830) 896-4200
Other names
- PETERSON REGIONAL MEDICAL CENTER
Other providers in Kerrville, TX
- Sid Peterson Memorial Hospital
- Sid Peterson Memorial Hospital
- Sid Peterson Memorial Hospital
- Sid Peterson Memorial Hospital
- Sid Peterson Memorial Hospital
- Sylvia Sieker
- Christine Faye Siftar
- John B. Silman
- Margaret Holman Simank
- Randolph Arthur Simank
All providers in Kerrville, TX · Rehabilitation Hospital Unit in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.