NPIMap

Organization Active NPI

Sid Peterson Memorial Hospital

Doing business as Peterson Regional Medical Center

  • Rehabilitation Hospital Unit
  • Kerrville, TX
National Provider Identifier
1992796239
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
000406 Issued in TX
Legal business name
SID PETERSON MEMORIAL HOSPITAL
Doing business as
Peterson Regional Medical Center
Practice address
551 Hill Country Dr
Kerrville, TX 78028-6085
Phone
(830) 896-4200
Fax
(830) 258-7678
NPI assigned
Nov 4, 2005
Last updated
Jul 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2022

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

Authorized official

Name
Ms. Lisa M Medovich, CPA
Title
Cfo
Phone
(830) 258-7632

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 000406 TX Primary

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 1

  • PETERSON REGIONAL 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
O20080804000036 TX Part A Provider - Hospital 6002724887 Practice locations: Kerrville, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992796239. Details of each certification follow.

Hospital certification: CCN 45T007

Legal name
SID PETERSON MEMORIAL HOSPITAL
Doing business as
PETERSON REGIONAL MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Feb 13, 1989 in TX
Enrollment address
551 Hill Country Dr
Kerrville, TX 78028-6085
Hospital Rehabilitation Unit
Hospital subgroups
General, Acute care, Rehabilitation unit

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

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Sid Peterson Memorial HospitalCCN 45T007 · All quality measures
Ownership
Non-profit
Certified
Jul 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
Progressive Health Cent6 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.

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Gaye Avery Individual Corporate DirectorBoard Member Jul 1, 2024
Michael D Ross Individual Corporate DirectorBoard Member Jul 1, 2024
Norman Williams Individual Corporate DirectorBoard Member Jul 1, 2022
Toni Manchester Individual Corporate DirectorBoard Member Jul 1, 2022
Rose Bradshaw Individual Corporate DirectorBoard Member Jul 1, 2022
Bobby Templton Individual Corporate Director Jul 1, 2026
James a Young Individual Corporate DirectorBoard Member Apr 30, 2019
Lisa M Medovich Individual Corporate OfficerChief Financial Officer Apr 30, 2019
W-2 Managing EmployeeChief Financial Officer Apr 30, 2019
Brian P Bowers Individual Corporate DirectorBoard Member Apr 30, 2019
Sid Peterson Memorial Hospital Organization, Kerrville, TX Corporation Operational/Managerial Control Jan 1, 1990
Joseph Thomas Piszczor Individual Corporate OfficerCoo Jul 14, 2020
W-2 Managing Employee Jul 14, 2020
Jeremy Walther Individual Corporate DirectorBoard Member Jul 1, 2024
Kendall Davison Individual Corporate DirectorBoard Member Jul 1, 2023
Johnathan W McDonald Individual Corporate OfficerPresident/Ceo May 27, 2025
W-2 Managing EmployeePresident/Ceo May 27, 2025
Christopher Ballesteros Individual W-2 Managing EmployeeCompliance Officer Apr 30, 2019
Thomas Houdeshell Individual Corporate DirectorBoard Member Jul 1, 2020
Kristen McAlexander Individual Corporate DirectorBoard Member Jul 1, 2023

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
Peterson Community Care Clinic RHCKerrville, TX, CCN 450007 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 1990
Jan 1, 1990
Peterson Home CareKerrville, TX, CCN 677052 Home health agency Operational/Managerial Control Feb 13, 2007
Peterson HospiceKerrville, TX, CCN 671585 Hospice 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 26, 2007
Apr 26, 2007
Peterson Community Care Clinic RHCKerrville, TX, CCN 678558 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 1990
Jan 1, 1990

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.

Practitioners & affiliated clinicians

Affiliated clinicians 6

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

NPI Registry JSON

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658880000000",
    "number": "1992796239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "551 HILL COUNTRY DR",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780286085",
            "telephone_number": "830-896-4200",
            "fax_number": "830-258-7678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "551 HILL COUNTRY DR",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780286085",
            "telephone_number": "830-896-4200",
            "fax_number": "830-258-7678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SID PETERSON MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-04",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A",
        "authorized_official_last_name": "MEDOVICH",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "830-258-7632",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "TX",
            "license": "000406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PETERSON REGIONAL MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PETERSON REGIONAL MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kerrville, TX

Sources for this page

Verify at the official NPI Registry.