NPIMap

Organization Active NPI

Christus Health Southeast Texas

Doing business as Christus Southeast Texas Family Practice Center - Kirbyville

  • Rural Health Clinic/Center
  • Kirbyville, TX
National Provider Identifier
1063485548
Registry record updated Oct 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CHRISTUS HEALTH SOUTHEAST TEXAS
Doing business as
Christus Southeast Texas Family Practice Center - Kirbyville
Practice address
205 E Lavielle St
Kirbyville, TX 75956-2119
Phone
(409) 423-2217
Fax
(409) 423-2421
NPI assigned
Feb 7, 2006
Last updated
Oct 19, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CHRISTUS HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 19, 2022

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

Authorized official

Name
Paul Trevino
Title
President / Ceo
Phone
(409) 899-7102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X TX Primary

Addresses

Primary practice location

205 E Lavielle St
Kirbyville, TX 75956-2119

Mailing address

PO Box 848060
Dallas, TX 75284-8060
Phone (800) 756-7999

Other identifiers 1

IdentifierTypeStateIssuer
137305206MedicaidTX

Other names 1

  • CHRISTUS SOUTHEAST TEXAS FAMILY PRACTICE CENTER - KIRBYVILLE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040707000434 TX Part A Provider - Rural Health Clinic 3476460049 Practice locations: Kirbyville, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063485548. Details of each certification follow.

Rural health clinic certification: CCN 453426

Legal name
CHRISTUS HEALTH SOUTHEAST TEXAS
Doing business as
CHRISTUS SOUTHEAST TEXAS FAMILY PRACTICE CENTER-KIRBYVILLE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 3, 1993
Last certification
Mar 19, 2019
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Jan 4, 1999 in TX
Enrollment address
205 E Lavielle St
Kirbyville, TX 75956-2119
Related CCNs
450573

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0869451Christus Southeast Texas Family Practice Center205 E Lavielle St, Kirbyville, TX 75956AccreditationAug 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Chistus Health5 organizations share this tax ID, including this one
Part of
Christus Health

Other organizations with this tax ID 4

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

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
Paul Trevino Individual Corporate OfficerCeo Jan 6, 2014
W-2 Managing EmployeeCeo Jan 6, 2014
Christus Health Organization, Irving, TX Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Feb 1, 1999 100%
Kim-Phuong Tran Individual Corporate DirectorBoard Member Jan 1, 2023
Dale a Staggemeier Individual W-2 Managing EmployeeMD; May 1, 2023
Kimberly King Webb Individual Corporate DirectorBoard Member Feb 7, 2024
Roy Steinhagen Individual Corporate DirectorBoard Member Jan 1, 2026
Shawn Michael Adams Individual Corporate OfficerCfo Mar 1, 2014
W-2 Managing EmployeeCfo Mar 1, 2014
Sonia Acosta Individual Corporate DirectorCorporate Secretary Sep 16, 2024
Fadi V Nasrallah Individual Corporate DirectorBoard Member Feb 7, 2024

Owners & managing parties with NPI records 1

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

Facilities with the same owner 47

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 47

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666137600000",
    "number": "1063485548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 848060",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752848060",
            "telephone_number": "800-756-7999",
            "fax_number": "469-282-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 E LAVIELLE ST",
            "city": "KIRBYVILLE",
            "state": "TX",
            "postal_code": "759562119",
            "telephone_number": "409-423-2217",
            "fax_number": "409-423-2421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTUS HEALTH SOUTHEAST TEXAS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHRISTUS HEALTH",
        "enumeration_date": "2006-02-07",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A",
        "authorized_official_last_name": "TREVINO",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "409-899-7102"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137305206",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHRISTUS SOUTHEAST TEXAS FAMILY PRACTICE CENTER - KIRBYVILLE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirbyville, TX

Sources for this page

Verify at the official NPI Registry.