NPIMap

Organization Active NPI

Community Health Clinic

  • Family Medicine Physician
  • Stephenville, TX
National Provider Identifier
1063407922
Registry record updated Nov 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E9244 Issued in TX
Legal business name
COMMUNITY HEALTH CLINIC
Practice address
160 River North Blvd
Stephenville, TX 76401-1803
Phone
(254) 968-6051
Fax
(254) 968-4950
NPI assigned
Sep 16, 2005
Last updated
Nov 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2025

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

Authorized official

Name
Ms. Jenna Sanchez
Title
Administrator
Phone
(254) 968-6051

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E9244 TX Primary
Pediatrics Physician 208000000X L2522 TX
Pediatrics Physician 208000000X K6312 TX
Family Nurse Practitioner 363LF0000X 251622 TX
Women's Health Nurse Practitioner 363LW0102X 456297 TX

Addresses

Primary practice location

160 River North Blvd
Stephenville, TX 76401-1803

Mailing address

160 River North Blvd
Stephenville, TX 76401-1803
Phone (254) 968-6051

Other identifiers 4

IdentifierTypeStateIssuer
135101703OtherTXMEDICAID CHILDREN SPECIAL
0072CPOtherTXGROUP TX PROV NUMBER
135101706MedicaidTX
017584601OtherTXMEDICAID TX HEALTH STEPS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100225000881 TX Part A Provider - Rural Health Clinic 9032253216 Practice locations: Stephenville, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063407922. Details of each certification follow.

Rural health clinic certification: CCN 453862

Legal name
COMMUNITY HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 5, 1992
Last certification
Apr 10, 2018
Ownership / control type
1C
Organization structure
PartnershipProprietary
Enrollment address
160 River North Blvd
Stephenville, TX 76401-1803

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14315/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.platform.athenahealth.com/20632/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Benjamin a Marcum Individual General Partnership InterestDoctor Nov 16, 2022 14.28%
Lester C Ong Individual General Partnership InterestDoctor Nov 16, 2022 14.28%
Miranda a Nash Individual General Partnership InterestDoctor Nov 16, 2022 14.28%
David C Boucher Individual General Partnership InterestDoctor Nov 16, 2022 14.28%
Clayton K Roberts Individual General Partnership InterestDoctor Nov 16, 2022 14.28%
Haley S Banks Individual General Partnership InterestDoctor Nov 16, 2022 14.28%
Jenna Sanchez Individual W-2 Managing EmployeeAdministrator Jun 1, 2017
Jeffrey D Moore Individual General Partnership InterestDoctor Nov 16, 2022 14.28%

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762819200000",
    "number": "1063407922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 RIVER NORTH BLVD",
            "city": "STEPHENVILLE",
            "state": "TX",
            "postal_code": "764011803",
            "telephone_number": "254-968-6051",
            "fax_number": "254-968-4950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 RIVER NORTH BLVD",
            "city": "STEPHENVILLE",
            "state": "TX",
            "postal_code": "764011803",
            "telephone_number": "254-968-6051",
            "fax_number": "254-968-4950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-16",
        "last_updated": "2025-11-11",
        "certification_date": "2025-11-11",
        "status": "A",
        "authorized_official_last_name": "SANCHEZ",
        "authorized_official_first_name": "JENNA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "254-968-6051",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "E9244",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "L2522",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "K6312",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "251622",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "TX",
            "license": "456297",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID CHILDREN SPECIAL",
            "identifier": "135101703",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP TX PROV NUMBER",
            "identifier": "0072CP",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135101706",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID TX HEALTH STEPS",
            "identifier": "017584601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stephenville, TX

Sources for this page

Verify at the official NPI Registry.