NPIMap

Organization Active NPI

Healthtexas Provider Network

Doing business as Pca Royse City

  • Rural Health Clinic/Center
  • Royse City, TX
National Provider Identifier
1063630937
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HEALTHTEXAS PROVIDER NETWORK
Doing business as
Pca Royse City
Practice address
6257 FM 2642 Blvd
Suite 100
Royse City, TX 75189-3223
Phone
(469) 800-3670
Fax
(469) 800-3680
NPI assigned
Apr 23, 2007
Last updated
May 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Authorized official

Name
Tonie Hall
Title
Operations Manager
Phone
(469) 800-3670

Specialties & licenses 1

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

Addresses

Primary practice location

6257 FM 2642 Blvd
Suite 100
Royse City, TX 75189-3223

Mailing address

PO Box 844128
Dallas, TX 75284-2148
Phone (469) 800-3524

Other identifiers 3

IdentifierTypeStateIssuer
091888002MedicaidTX
8G4495OtherTXBCBS PROVIDER #
137940601MedicaidTX

Other names 1

  • PCA ROYSE CITY Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161011000438 TX Part A Provider - Rural Health Clinic 1355254210 Practice locations: Royse City, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063630937. Details of each certification follow.

Rural health clinic certification: CCN 673931

Legal name
HEALTHTEXAS PROVIDER NETWORK
Doing business as
PCA ROYSE CITY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 14, 2015
Last certification
Oct 14, 2015
Ownership / control type
1B
Most recent change of ownership
Jun 1, 2016 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Apr 5, 1994 in TX
Enrollment address
6257 FM 2642
Suite 100
Royse City, TX 75189-3224

National Provider Directory

National Provider Directory
Tax ID family
Family Medical Center78 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

Locations

125 W Interstate 30
Ste L
Royse City, TX 75189
Phone (903) 408-7700

6257 FM 2642 Blvd
Royse City, TX 75189
Phone (469) 800-3670

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Jennifer S Reeves Individual Corporate DirectorDirector Jul 1, 2017
W-2 Managing EmployeeDirector Jul 1, 2017

Practitioners & affiliated clinicians

Practitioners 6

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": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1063630937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844128",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752842148",
            "telephone_number": "469-800-3524",
            "fax_number": "469-800-3564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6257 FM 2642 BLVD",
            "address_2": "SUITE 100",
            "city": "ROYSE CITY",
            "state": "TX",
            "postal_code": "751893223",
            "telephone_number": "469-800-3670",
            "fax_number": "469-800-3680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHTEXAS PROVIDER NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "TONIE",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "469-800-3670"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "091888002",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "8G4495",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137940601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PCA ROYSE CITY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PCA ROYSE CITY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Royse City, TX

Sources for this page

Verify at the official NPI Registry.