NPIMap

Organization Active NPI

Health Center of Southeast Texas

  • Federally Qualified Health Center (FQHC)
  • Dayton, TX
National Provider Identifier
1063017135
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEALTH CENTER OF SOUTHEAST TEXAS
Practice address
2206 N. Cleveland
Dayton, TX 77535
Phone
(281) 592-2224
NPI assigned
Dec 4, 2020
Organization subpart
Yes
Parent organization
HEALTH CENTER OF SOUTHEAST TEXASAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

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

Authorized official

Name
Steven Racciato
Title
Ceo
Phone
(281) 592-2224

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

2206 N. Cleveland
Dayton, TX 77535

Mailing address

307 N William Barnett Ave
Cleveland, TX 77327-4061
Phone (281) 592-2224

Other names 1

  • Health Center of Southeast Texas Dayton Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060223000543 TX Part B Supplier - Clinic/Group Practice 9739195041 Receives reassigned benefits from 22 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cleveland, TX; Shepherd, TX; Livingston, TX; Liberty, TX; Dayton, TX
O20210224001393 TX Part A Provider - Federally Qualified Health Center (FQHC) 9739195041 Practice locations: Dayton, TX

Federally qualified health center certification: CCN 451139

Legal name
HEALTH CENTER OF SOUTHEAST TEXAS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 1, 2021
Last certification
Apr 1, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 14, 2005 in TX
Enrollment address
2206 N Cleveland St
Dayton, TX 77535-1658

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Health Center of Southeast6 organizations share this tax ID, including this one
Part of
Health Center of Southeast

Other organizations with this tax ID 5

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

Locations

2206 N Cleveland St
Dayton, TX 77535
Phone (281) 592-2224

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Susan Bailes Individual Corporate Director Jul 18, 2013
Ilona Molton Individual Corporate Director Oct 9, 2014
Walter Scott Lambert Individual Corporate DirectorBoard of Directors Jan 1, 2025
Jennifer L Bergman Individual Corporate Director Jan 14, 2016
Sherrell Wolfe Individual Corporate Director Jul 18, 2013
Eisha Jones Individual Corporate Director Feb 11, 2016
Magdalena Estrada Individual Corporate OfficerChief Executive Officer May 4, 2026
Corporate DirectorChief Executive Officer May 4, 2026
W-2 Managing EmployeeChief Executive Officer May 4, 2026
Kari Rhodes Individual Corporate DirectorBoard of Directors Jan 1, 2025
James Smith Individual Corporate Director Sep 12, 2019

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1607040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687219200000",
    "number": "1063017135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 N WILLIAM BARNETT AVE",
            "city": "CLEVELAND",
            "state": "TX",
            "postal_code": "773274061",
            "telephone_number": "281-592-2224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2206 N. CLEVELAND",
            "city": "DAYTON",
            "state": "TX",
            "postal_code": "77535",
            "telephone_number": "281-592-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH CENTER OF SOUTHEAST TEXAS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEALTH CENTER OF SOUTHEAST TEXAS",
        "enumeration_date": "2020-12-04",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A",
        "authorized_official_last_name": "RACCIATO",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "281-592-2224"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Center of Southeast Texas Dayton",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Health Center of Southeast Texas Dayton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dayton, TX

Sources for this page

Verify at the official NPI Registry.