MEMORIAL MEDICAL CENTER
NPI 1104203181
Surgery in Port Lavaca, TX
About Memorial Medical Center NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MEMORIAL MEDICAL CENTER (NPI 1104203181) is a healthcare organization registered as a surgery in Port Lavaca, Texas and active in the NPI registry since April 2015. The organization lists Erin Clevenger, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Memorial Medical Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by February 28, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
16Medicare enrollment records show 16 clinicians reassign Medicare billing to Memorial Medical Center, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 14 within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 6
Clinicians, nearest first (16)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Memorial Medical Center's NPI number?
The NPI number for Memorial Medical Center is 1104203181. It was assigned to this organization in the NPPES registry on April 29, 2015.
Where is Memorial Medical Center located?
Memorial Medical Center is located at 815 N Virginia St, Port Lavaca, TX 77979. The listed phone number is (361) 552-6713.
What is Memorial Medical Center's specialty?
The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.
Is Memorial Medical Center enrolled in Medicare?
Yes. Memorial Medical Center is registered in the Medicare PECOS enrollment system.
When is Memorial Medical Center's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Texas, Clinic/Group Practice) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Memorial Medical Center?
According to the CMS Revalidation Reassignment List (October 2026 release), 16 clinicians in 6 Medicare specialties reassign their Medicare billing to Memorial Medical Center. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Certified Registered Nurse Anesthetist (CRNA) (5), Nurse Practitioner (5) and Family Practice (3). Of these, 3 practice at this address and 14 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Memorial Medical Center accept?
Health plans from Blue Cross and Blue Shield of Texas list Memorial Medical Center as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Memorial Medical Center was last updated on July 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Memorial Medical Center · NPI 1104203181
Surgery organization in Port Lavaca, Texas. Organization record, active in the CMS NPPES registry since April 29, 2015.
## Identity
- **NPI:** 1104203181 (Entity type: Organization)
- **Enumerated:** April 29, 2015
- **Primary specialty:** Surgery · taxonomy 208600000X
- **Organization subpart:** No
- **Authorized official:** Erin Clevenger, CEO
## Practice location
- **Address:** 815 N VIRGINIA ST, Port Lavaca, TX 77979-3025
- **Phone:** (361) 552-6713 · **Fax:** (361) 552-0220
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** February 28, 2027 (Non-DME Part B, Texas, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 16 clinicians in 6 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Certified Registered Nurse Anesthetist (CRNA) (5), Nurse Practitioner (5), Family Practice (3); 3 practice at this address and 14 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 6, 2026
- **Other identifiers:** Other T225 (TX); Medicaid 137909103 (TX)
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Source: [NPI Profile](https://npiprofile.com/npi/1104203181) · Data from the CMS NPPES public registry.