Community Healthcare of Texas

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

007477 Issued in TX

Legal business name

COMMUNITY HEALTHCARE OF TEXAS

Doing business as

Providence Hospice

Practice address

6700 Sanger Avenue
Waco, TX 76710

Phone

(254) 399-9099

Fax

(254) 399-8397

NPI assigned

Jun 10, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Victoria Jingle

Title

Ceo

Phone

(817) 870-2795

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Providence Hospice Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043214638. Details of each certification follow.

• CCN 451713 Hospice · Active · Details

Hospice certification: CCN 451713

Legal name

COMMUNITY HEALTHCARE OF TEXAS

Doing business as

PROVIDENCE HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jan 2, 2002

Last certification

Dec 18, 2020

Ownership / control type

Non-Profit - Private

Organization structure

CorporationProprietary

Incorporated

May 1, 1996 in TX

Enrollment address

6700 Sanger Ave
Waco, TX 76710-4255

Other NPIs with the same Medicare PAC ID 1

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

• Community Healthcare of Texas

  dba Community Hospice of Texas

  • Community Based Hospice Care Agency
  • Fort Worth, TX
  • NPI 1275537219

  5991712564

  Same PAC ID

Listed as

Providence HospiceCCN 451713 · All quality measures

Ownership

Non-Profit

Certified

Jan 2, 2002

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Community Healthcare of Texas2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Community Healthcare of Texas

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Fort Worth, TX
  • NPI 1942513486
  NPD tax ID

Locations

All disclosed owners & managing parties 3

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

Affiliated clinicians 4

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

• Roxann M Samples, M.D.

  • Internal Medicine Physician
  • Waco, TX
  • NPI 1184796252

  Hospice

  Care Compare affiliation
• Jeremiah Brent Seely, MD

  • Family Medicine Physician
  • Hillsboro, TX
  • NPI 1073753448

  Hospice

  Care Compare affiliation
• Christopher Vera, DO

  • Family Medicine Physician
  • Waco, TX
  • NPI 1760863153

  Hospice

  Care Compare affiliation
• Joshua Wesley, MD

  • Family Medicine Physician
  • Waco, TX
  • NPI 1942612783

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672704000000",
    "number": "1043214638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 WESTERN PLACE",
            "address_2": "SUITE 105",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76107",
            "telephone_number": "817-870-2795",
            "fax_number": "817-878-3717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6700 SANGER AVENUE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "76710",
            "telephone_number": "254-399-9099",
            "fax_number": "254-399-8397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTHCARE OF TEXAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-10",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A",
        "authorized_official_last_name": "JINGLE",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-870-2795",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "TX",
            "license": "007477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001019692",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000201900",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Dulan Collins, D.D.S.
• Khalil S Coltrain, A.T.C.
• Ronald E Colunga, PAC
• Alfonso N Combong, C.R.N.A.
• Community Doulas of Waco
• Compleat Physicians PLLC
• Compleat Physicians, PLLC
• Complete Women's Care, PLLC
• Concentra Health Services, Inc.
• Concentra Primary Care PA (Concentra Primary Care)

• Community Based Hospice Care Agency in Waco, TX
• Providers in Waco, TX by specialty
• Community Based Hospice Care Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.