Section I. RHP Organization

Section I. RHP Organization TABLE 1-1. RHP PARTICIPANT & STAKEHOLDER INFORMATION RHP Participant Texas Provider Texas Identification Ownership Organization Name Lead Representative Lead Representative Contact Information Type Identifier (TPI) Number (TIN) Type ANCHORING ENTITY Texas A&M Health Science Center 1266 TAMU Academic Ms. Shayna Spurlin College Station, TX 77843-1266 Health Science Texas A&M Health RHP 17 Program [email protected] Center 198523601 3-709709709-3-000 State owned Science Center Director 979-436-9140 IGT ENTITIES 8441 State Hwy. 47 Brett Giroir, MD Clinical Bldg. 1, Suite 3100 Academic CEO & Executive Vice Bryan, TX 77807 Health Science President [email protected] Center Texas A&M Health 979-436-9100 3-709709709-3-000 State-owned Science Center IGT: Jeff Burton IGT Transfers: [email protected] P.O. Box 4588 Bryan, TX 77805 Community [email protected] Mental Health Non State- MHMR Authority of Mr. Bill Kelly 979-361-9840 Center (CMHC) 1-74-1793265-8-004 owned Public Brazos Valley Executive Director IGT Transfers: Same 1506 FM 2854 Conroe, TX 77304-2206 Community [email protected] Mental Health Non State- Mr. Evan Roberson 936-521-6119 Center (CMHC) 1-76-0032662-7-001 owned Public Tri-County Services Executive Director IGT Transfers: Same Brazos County Administration Building 200 South Texas, Suite 332 Hon. Duane Peters Bryan, TX 77803 County Judge [email protected] Non State- 979-361-4102 County 1-74-6000433-0-038 owned Public Brazos County IGT: Irene Jett IGT Transfers: [email protected] P.O. Box 160 Hon. Ben Leman Anderson, TX 77830 County Judge [email protected] Non State- 936-873-4476 County 1-74-6000041-1-000 owned Public Grimes County IGT: Jessi Murphy IGT Transfers: [email protected]

RHP Plan for RHP 17 – May 2015 – Section I: RHP Organization _ TABLE 1-1. RHP PARTICIPANT & STAKEHOLDER INFORMATION RHP Participant Texas Provider Texas Identification Ownership Organization Name Lead Representative Lead Representative Contact Information Type Identifier (TPI) Number (TIN) Type

IGT Entities (continued) P.O. Box 429 Hon. Byron Ryder Centerville, TX 75833 County Judge [email protected] Non State- 903-536-2331 County 1-74-6000503-0-003 owned Public Leon County IGT: Brandi Hill IGT Transfers: [email protected] 101 W. Main St., Rm 110 Hon. C.E. McDaniel, Jr. Madisonville, TX 77864 County Judge [email protected] Non State- 936-348-2670 County 1-74-6001672-2-017 owned Public Madison County IGT: Judi Delesandri IGT Transfer: [email protected] P.O. Box 427 Franklin, TX 77856 Non State- Hon. Charles Ellison [email protected] County 1-74-6000871-1-019 owned Public Robertson County County Judge 979-828-3542 100 East Main, Ste. 104 Hon. John Brieden Brenham, TX 77833-3753 County Judge [email protected] Non State- 979-277-6200 County 1-74-6000408-2-024 owned Public Washington County IGT: Sharon Stolz IGT Transfers: [email protected] 132 E. Hospital Drive Angleton, TX 77515 [email protected] Non State- Angleton Danbury Mr. David Bleakney 979-849-7721 Hospital District 1-74-1612400-0-000 owned Public Hospital District Chief Executive Officer IGT Transfers: Same 44 N. Cummings Bellville, TX 77418 [email protected] Non State- Bellville County Mr. Clay Kistler 979-865-2678 Hospital District 1-76-0636528-0-555 owned Public Hospital District Board Chairman IGT Transfers: Same P.O. Box 456 Caldwell, TX 77836 [email protected] Non State- Burleson County Mr. Kirk Chapman 979-567-3245 Hospital District 1-74-1820731-6-555 owned Public Hospital District President IGT Transfers: Same

IGT Entities (continued) 815 North Virginia Street Port Lavaca, TX 77979 Calhoun County [email protected] Non State- Hospital District dba Mr. Jason Anglin 361-552-0222 Hospital District 1-74-6003411-3-000 owned Public Memorial Medical Ctr Chief Executive Officer IGT Transfers: Same P.O.Box 398 Anahuac, Texas 77514 Chambers County [email protected] Non State- Public Hospital District Mr. Steven Gularte 409-267-3143 Hospital District 1-76-0153629-9-003 owned Public #1 Chief Executive Officer IGT Transfers: Same 4815 Alameda Ave. El Paso, TX 79905 Mr. James Valenti [email protected] Non State- El Paso County President & Chief 915-521-7601 Hospital District 1-74-6000756- 4-013 owned Public Hospital District Executive Officer IGT Transfers: Same 1110 N Sarah DeWitt Dr. Gonzales TX, 78629 [email protected] Non State- Gonzales County Mr. Chuck Norris 830-672-8495 Hospital District 1-74-1625013-6-501 owned Public Hospital District Chief Executive Officer IGT Transfers: Same 2525 Holly Hall Drive Houston, TX 77054 [email protected] Non State- Harris County Mr. Mike Norby 713-566-6400 Hospital District 1-74-1536936-6-324 owned Public Hospital District Chief Financial Officer IGT Transfers: Same 1013 South Wells Street Edna, Texas 77957 [email protected] Non State- Jackson County Mr. Bill Jones (361) 782-7810 Hospital District 1-74-1738475-1-002 owned Public Hospital District Chief Executive Officer IGT Transfers: Same 624 Fannin Liberty, TX 77575 [email protected] Non State- Liberty County Mr. C. Bruce Stratton 936-336-7400 Hospital District 1-20-2797853-0-000 owned Public Hospital District #1 President IGT Transfers: Same TABLE 1-1. RHP PARTICIPANT & STAKEHOLDER INFORMATION

RHP Plan for RHP 17 – May 2015 – Section I: RHP Organization _ RHP Participant Texas Provider Texas Identification Ownership Organization Name Lead Representative Lead Representative Contact Information Type Identifier (TPI) Number (TIN) Type

IGT Entities (continued) 104 7th Street Bay City, TX 77414 [email protected] Non State- Matagorda County Bryan Prochnow 979-241-5525 Hospital District 1-74-6025069-3-001 owned Public Hospital District Chief Financial Officer IGT Transfers: Same P.O. Box 0478 Mr. Randy Johnson Conroe, TX 77305 Executive Director [email protected] Non State- Montgomery County 936-523-5001 Hospital District 1-74-1772120-0-003 owned Public Hospital District IGT: Brett Allen IGT Transfers: [email protected] 305 N McKinney Sweeny TX 77480 [email protected] Non State- Sweeny Hospital Mrs. Hong Wade 979-548-1500 Hospital District 1-74-1498067-6-001 owned Public District Chief Financial Officer IGT Transfers: Same P.O. Box 1267 Huntsville, TX 77340 [email protected] Non State- Walker County Mr. Robert Hardy 936-295-0038 Hospital District 1-74-2086610-9-000 owned Public Hospital District Chairman IGT Transfers: Same 303 Sandy Corner Road El Campo, TX 77437 [email protected] Non State- West Wharton County Ms. Tisha Zalman 979-543-6251 Hospital District 1-76-0488120-5-000 owned Public Hospital District Chief Executive Officer IGT Transfers: Same 201 North Texas Avenue Mr. Ken Bost Bryan, TX 77803-5317 Director [email protected] Local Health Non State- Brazos County Public 979-361-5715 Department 1-74-6000433-0-038 owned Public Health District IGT: Brian Pratt IGT Transfers: [email protected] PO Box 4128 Bryan, TX 77805-4128 Regional [email protected] Planning Non State- Brazos Valley Council Mr. Tom Wilkinson 979-595-2801 Commission 1-74-1562020-6-002 owned public of Governments Executive Director IGT Transfers: Same TABLE 1-1. RHP PARTICIPANT & STAKEHOLDER INFORMATION

RHP Plan for RHP 17 – May 2015 – Section I: RHP Organization _ RHP Participant Texas Provider Texas Identification Ownership Organization Name Lead Representative Lead Representative Contact Information Type Identifier (TPI) Number (TIN) Type PERFORMING PROVIDERS P.O. Box 4588 Community Mr. Robert Reed Bryan, TX 77805 Mental Health Non State- MHMR Authority of Director, Mental [email protected] Center (CMHC) 136366507 1-74-1793265-8-004 owned Public Brazos Valley Health Services 979-821-9401 Ms. Cynthia Peterson 1506 FM 2854 Community Medicaid Conroe, TX 77304-2206 Mental Health Non State- Transformation [email protected] Center (CMHC) 081844501 1-76-0032662-7-001 owned Public Tri-County Services Waiver Administrator 936-521-6122 201 North Texas Avenue Ms. Sara Mendez Bryan, TX 77803-5317 Local Health Non State- Brazos County Health Health Education & [email protected] Department 130982504 1-74-6000433-0-038 owned Public Department Promotion Director 979-361-5730 Mr. Andrew Karrer 1400 South Loop 336 West Community Conroe, TX 77304 Local Health Non State- Montgomery County Paramedicine Program [email protected] Department TPI: 311035501 1-46-0698418-6-000 owned Public Public Health District Manager 936-523-1103 Physician Group 8441 State Highway 47 Associated with Dr. Nancy W. Dickey Clinical Building 1, Suite 3100 Academic Interim Chair, Clinical Bryan, TX 77807 Health Science Texas A&M Physicians & Translational [email protected] Center 198523601 3-709709709-3-000 State Owned Group Medicine 979-436-0399 Ms. Vicky Cha Bridier 1604 Rock Prairie Road Chief Operating College Station, TX 77845 Private For- College Station Officer & Facility [email protected] Private Hospital 020860501 1-62-1762360-8-002 profit Medical Center Compliance Officer 979-680-5412 504 Medical Center Blvd Conroe, TX 77304 Private For- Conroe Regional Mr. Thomas Holt [email protected] Private Hospital 020841501 1-62-1801361-9-003 profit Medical Center Chief Financial Officer 936-539-7413 110 Memorial Hospital Drive P.O. Box 4001 Huntsville, TX 77342-4001 Private Non- Huntsville Memorial Mr. Shannon Brown [email protected] Private Hospital 189791001 1-20-3069241-7-000 profit Hospital Chief Executive Officer 936-435-2230 TABLE 1-1. RHP PARTICIPANT & STAKEHOLDER INFORMATION

Performing Providers (continued) 3000 Briarcrest Drive, Suite 418 Mr. Jason Jennings Bryan, TX 77802 Private Non- Baylor Scott & White Chief Executive Officer [email protected] Private Hospital 135226205 1-74-2519752-6-000 profit Hospital Brenham College Station Region 979-836-6173 Mr. Tim Ottinger 2801 Franciscan Drive Advocacy, Legislative Bryan, TX 77802 Private Non- St. Joseph Regional Affairs, & Community [email protected] Private Hospital 127267603 1-74-1282696-2-501 profit Health Center Benefits Officer 979-776-3777 CHI St. Luke’s Hospital System CHI St. Luke’s 3100 Main St., Suite 569 Community Medical Mr. Ken Zieren Houston, TX 77002 Private Non- Center – The Administrative [email protected] Private Hospital 160630301 1-76-0536234-6-005 Profit Woodlands Director 832-355-3862 UC-ONLY HOSPITALS Mr. Tim Ottinger 1101 Woodson Drive Advocacy, Legislative Caldwell, TX 77836 Private Non- Burleson St. Joseph Affairs, & Community [email protected] Private Hospital 112725003 1-74-2759890-3-000 Profit Health Center Benefits Officer 979-776-3777 CHI St. Luke’s Hospital System 3100 Main St., Suite 569 Mr. Ken Zieren Houston, TX 77002 Private Non- CHI St. Luke’s Lakeside Administrative [email protected] Private Hospital 210274101 1-30-0427437-2-002 Profit Hospital Director 832-355-3862 Mr. Tim Ottinger 210 South Judson Advocacy, Legislative Navasota, TX 77868 Private Non- Grimes St. Joseph Affairs, & Community [email protected] Private Hospital 147918003 1-74-1282696-2-002 Profit Health Center Benefits Officer 979-776-3777 22999 US Highway 59 North Ms. Melinda Kingwood, TX 77339 Private For- Kingwood Medical Stephenson [email protected] Private Hospital 112724302 1-62-1619857-8-002 Profit Center Chief Executive Officer 281-348-8000 TABLE 1-1. RHP PARTICIPANT & STAKEHOLDER INFORMATION

UC-ONLY HOSPITALS (continued)

Mr. Tim Ottinger 100 W. Cross Street Advocacy, Legislative Madisonville, TX 77864 Private Non- Madison St. Joseph Affairs, & Community [email protected] Private Hospital 020990001 1-74-2761145-8-005 Profit Health Center Benefits Officer 979-776-3777

3550 Normand Drive Private Private College Station, TX 77845 Psychiatric Psychiatric Rock Prairie Mr. Jim Serratt [email protected] Hospital TPI: In Progress 3-20-4877239-9-000 Hospital Behavioral Health Chief Executive Officer 979-703-8848 OTHER STAKEHOLDERS

5425 Polk, Suite J Mail Code 1906 Houston, TX 77023 Regional Public Texas Public Health Dr. Julie Graves [email protected] Health Director Region 6/5 South Region 5S/6 Director 713-767-3000 2408 South 37th Street Mail Code 1902 Temple, TX 76504 Regional Public Texas Public Health Dr. Sharon Melville [email protected] Health Director Region 7 Director Region 7 Director 254-778-6744

110 Highway 290 Brenham Express and Washington County Brenham, TX 77833 Clinic Family Medicine (St. Joseph System) 979-830-5584

Leon County 1686 West US 79 (College Station Buffalo, TX 75831 Clinic Family Care Center Medical Center) 903-322-2204

Huntsville Memorial 521 IH-45 South, Suite 4 Hospital Medical Walker County Huntsville, TX 77340 Clinic Clinic (Huntsville Memorial) 936-291-3240

RHP Plan for RHP 17 – May 2015 – Section I: RHP Organization _ TABLE 1-1. RHP PARTICIPANT & STAKEHOLDER INFORMATION RHP Participant Texas Provider Texas Identification Ownership Organization Name Lead Representative Lead Representative Contact Information Type Identifier (TPI) Number (TIN) Type OTHER STAKEHOLDERS (continued) Huntsville Memorial 1613 East Main Hospital Medical Clinic Madison County Madisonville, TX 77864 Clinic - Madisonville (Huntsville Memorial) 936-349-0350 501 East Washington Navasota Medical Navasota, TX 77868 Clinic Center Grimes County 936-825-6444 702 Main Street The Rural Healthcare Calvert, TX 77837 Clinic Center Robertson County 979-364-3888

1600 University Drive College Station, TX 77840 Scott & White Clinic – Ms. Linda Clark [email protected] Clinic College Station Administrator 979-691-3300

1414 S. Frazier, Suite 105 Conroe, TX 77301 St. Hope Foundation [email protected] Conroe Clinic & Dental Montgomery County Clinic: 936-441-2440 Clinic Services (St. Hope Foundation) Dental: 713-778-0827

St. Joseph Family 9409 State Highway 6 Medicine Clinic - St. Joseph Hospital Navasota, TX 77868 Clinic Navasota System 936-825-7200

PO Box 5913 Bryan, TX 77805 Community Free Ms. Elizabeth Dickey [email protected] Clinic Health For All Executive Director 979-774-4176

100 S. Chappell Hill St. Washington County Brenham, TX 77833 Community Free Health & Services Rev. Randy Wells [email protected] Clinic Center Faith Mission Executive Director 979-251-9882

OTHER STAKEHOLDERS (continued) 100 West Buck, Suite 306 Caldwell, TX 77836 Non State- Hon. Mike Sutherland [email protected] County 1-74-6000467-8-023 owned Public Burleson County County Judge 979-567-2333 501 North Thompson, Suite 401 Conroe, TX 77301 Non State- Hon. Craig Doyal [email protected] County 1-74-6000558-4-020 owned Public Montgomery County County Judge 936-539-7812 1100 University Avenue, Room 204 Huntsville, TX 77340 Non State- Hon. Danny Pierce [email protected] County 1-74-6001432-1-016 owned Public Walker County County Judge 936-436-4910 1875 Hwy 290 West Brenham, TX 77833 Non-State Washington County Mr. Kevin Deramus [email protected] County EMS 000122401 1-74-6000408-2-003 owned Public EMS Director 979-277-6267 Anderson-LEON 3201 S. Loop 256, Suite 610 County Medical County Medical Dr. Joseph Tretta Palestine, TX 75801-6905 Society Society President 903-729-6768 Austin-GRIMES-Waller 3433 Hwy 36 South County Medical County Medical Dr. Wilford Morris, Jr. Sealy, TX 77474-3854 Society Society President 979-885-0848 3201 University Drive East, Suite 345 BRAZOS-ROBERTSON Bryan, TX 77802-3484 County Medical County Medical Dr. Mark Florian [email protected] Society Society President 979-731-8465 PO Box 133067 MONTGOMERY The Woodlands, TX 77393 County Medical County Medical Mr. Paul Purcell [email protected] Society Society Executive Director 281-298-9655

RHP Plan for RHP 17 – May 2015 – Section I: RHP Organization _ TABLE 1-1. RHP PARTICIPANT & STAKEHOLDER INFORMATION RHP Participant Texas Provider Texas Identification Ownership Organization Name Lead Representative Lead Representative Contact Information Type Identifier (TPI) Number (TIN) Type OTHER STAKEHOLDERS (continued) WALKER-MADISON- 100 Medical Center Pkwy, Suite 500 County Medical TRINITY County Dr. Curtis Huntsville, TX 77340-4965 Society Medical Society Montgomery 936-291-0614 WASHINGTON- 605 Medical Court, Suite 203 County Medical BURLESON County Brenham, TX 77833 Society Medical Society Dr. Jon Bode 979-836-2822 1500 University Drive East, Suite 100 Brazos Valley College Station, TX 77840 Community Action [email protected] FQHC Agency (BVCAA) Ms. Karen Garber 979-846-1100 1651 Rock Prairie Road College Station, TX 77845 FQHC HealthPoint ABC Brazos County 979-693-7400 3370 S. Texas Avenue, Suite B HealthPoint Bryan, TX 77802 FQHC Bryan/College Station Brazos County 979-595-1700 624 Mary Lake HealthPoint Mary Lake Bryan, TX 77801 FQHC Dental Brazos County 979-846-2500 600 Memory Lane HealthPoint Somerville, TX 77879 FQHC Somerville Burleson County 979-596-1441 302 W. Hwy. 21 Caldwell Community Caldwell, TX 77836 FQHC Health Clinic Burleson County 979-567-3287 101 Pine Manor Road The Community Oak Ridge North, TX 77385 FQHC Dental Center Montgomery County 936-539-4004 Family Health Center, 506 Medical Center Blvd., Suite 320 Pedi Dental & Medical Conroe, TX 77304 FQHC Services Montgomery County 936-523-5292 1905 Dove Crossing, Suite C Navasota, TX 77868 FQHC HealthPoint Navasota Grimes County 936-825-0000

RHP Plan for RHP 17 – May 2015 – Section I: RHP Organization _ TABLE 1-1. RHP PARTICIPANT & STAKEHOLDER INFORMATION RHP Participant Texas Provider Texas Identification Ownership Organization Name Lead Representative Lead Representative Contact Information Type Identifier (TPI) Number (TIN) Type OTHER STAKEHOLDERS (continued) 100 W. Cross Street Madisonville, TX 77864 HealthPoint 409-348-3418 FQHC Madisonville Madison County 709 Barton Street Hearne, TX 77859 FQHC HealthPoint Hearne Robertson County 979-279-3451 607 Lassater Street HealthPoint Centerville, TX 75833 FQHC Centerville Leon County 903-536-3687 Lone Star Family 704 Old Montgomery Road Health Ctr – Region Conroe, TX 77301 FQHC 5S/6 FQHC Admin. Montgomery County 936-539-4004 Madison County 813 South State Street Community Health Madisonville, TX 77864 FQHC Center Madison County 936-348-3396 1002 West Brown Street HealthPoint Robertson Hearne, TX 77859 FQHC County CHC Robertson County 979-279-0701 808 W. Highway 79 St. Joseph HealthPoint Franklin, TX 77856 FQHC Franklin Robertson County 979-828-4540 19221 I-45 South, Suite 190 Hospice Aseracare Hospice Montgomery County Shenandoah, TX 77385 2040 N. Loop 336 West, Suite 324 Conroe, TX 77304 Hospice Embracing Hospice Montgomery County 936-788-5900 502 W. 26th Street Bryan, TX 77803 Hospice Brazos Valley, Craig Borchardt, PhD [email protected] Hospice 000203700 Inc. President/CEO 979-821-2266 200 Riverpointe Hospice Lighthouse Hospice Montgomery County Conroe, TX 77304

RHP Plan for RHP 17 – May 2015 – Section I: RHP Organization _ TABLE 1-1. RHP PARTICIPANT & STAKEHOLDER INFORMATION RHP Participant Texas Provider Texas Identification Ownership Organization Name Lead Representative Lead Representative Contact Information Type Identifier (TPI) Number (TIN) Type OTHER STAKEHOLDERS (continued) 100 I-45 N, Suite 300, Box 103 Odyssey Hospice of Conroe, TX 77301 Hospice Conroe Montgomery County 936-788-7707 PO Box 6548 Huntsville, TX 77342 Hospice Thee Hospice Walker County 936-291-8439 1862 Rock Prairie Road, Suite 204 College Station, TX 77845 Hospice Traditions Hospice Brazos County 979-822-5511 9250 Pinecroft Memorial Hermann The Woodlands, TX 77380 The Woodlands Mr. Josh Urban [email protected] Private Hospital Hospital CEO 713-897-2300 Aspire Behavioral 2006 S. Loop 336 West, Suite 500 Private Health of Conroe, LLC Conroe, TX 77304 Specialty – Geriatric Psychiatric [email protected] Hospital Hospital Montgomery County 936-647-3500 Washington County 600 North Park Street Rural Health (College Station Brenham, TX 77833 Clinic Brenham Clinic Medical Center) 979-836-6153 Falls Community Robertson County 201 South Main St Rural Health Hospital Clinic - (Falls Community Bremond, TX 76629 Clinic Bremond Hospital (Marlin)) 254-746-7264 Huntsville Memorial 125 Medical Park Lane Suite C Rural Health Hospital Medical Walker County Huntsville, TX 77340 Clinic Clinic (Huntsville Memorial) 936-291-3219 3638 State Highway 19 Rural Health Huntsville Memorial Walker County Riverside, TX 77340 Clinic Hospital Medical Clinic (Riverside) 936-436-5560 539 Medical Parkway Rural Health Scott & White Family Washington County Brenham, TX 77833 Clinic Practice – Brenham (Scott & White) 979-836-1883 910 Highway 3 West Rural Health St. Joseph Normangee Leon County Normangee, TX 77871 Clinic Family Medicine Clinic (St. Joseph System) 936-396-2806

RHP Plan for RHP 17 – May 2015 – Section I: RHP Organization _ TABLE 1-1. RHP PARTICIPANT & STAKEHOLDER INFORMATION RHP Participant RHP Participant Type RHP Participant Type RHP Participant Type RHP Participant Type Type OTHER STAKEHOLDERS (continued) 2911 Texas Avenue South, Suite 103 Urgent Care Brazos Valley Urgent College Station, TX 77845 Clinic Care Clinic Brazos County 979-764-2882 1048 Railroad Street Urgent Care Buffalo Urgent & Buffalo, TX 75831 Clinic Family Care Clinic Leon County 903-322-9309 Urgent Care Montgomery County 15320 Highway 105 West, Suite 120 Clinic NextCare Urgent Care (partial) Montgomery, TX 77356

RHP Plan for RHP 17 – May 2015 – Section I: RHP Organization _