NPIMap

Organization Active NPI

Matagorda Episcopal Health Outreach Program

Doing business as Vibrance Health

  • Dentist
  • Bay City, TX
National Provider Identifier
1073703575
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MATAGORDA EPISCOPAL HEALTH OUTREACH PROGRAM
Doing business as
Vibrance Health
Practice address
205 Ida Ave
Bay City, TX 77414-3167
Phone
(979) 245-2008
Fax
(979) 245-0242
NPI assigned
Jul 31, 2007
Last updated
Jan 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

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

Authorized official

Name
Celeste Harrison
Title
Ceo
Phone
(979) 245-2008

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 671914 TX
Dentist 122300000X NU Primary

Addresses

Primary practice location

205 Ida Ave
Bay City, TX 77414-3167

Mailing address

101 Avenue F N
Bay City, TX 77414-3167
Phone (979) 245-2008

Other identifiers 1

IdentifierTypeStateIssuer
347977601MedicaidTX

Other names 2

  • Vibrance Health Doing business as
  • MEHOP Oral Health Clinic Other name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address Patientcare@mehop.org Direct
CONNECT URL credentialing@mehop.org Direct

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050415000038 TX Part B Supplier - Clinic/Group Practice 6002853538 Receives reassigned benefits from 31 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bay City, TX; Palacios, TX; Wharton, TX
O20090720000152 TX Part A Provider - Federally Qualified Health Center (FQHC) 6002853538 Practice locations: Bay City, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073703575. Details of each certification follow.

Federally qualified health center certification: CCN 671914

Legal name
MATAGORDA EPISCOPAL HEALTH OUTREACH PROGRAM CORPORATION
Doing business as
VIBRANCE HEALTH DENTAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 24, 2009
Last certification
Jul 24, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 2003 in TX
Enrollment address
205 Ida Ave
Bay City, TX 77414-3144

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

205 Ida Ave
Bay City, TX 77414
Phone 9792452008302

Interoperability endpoints

  • Direct secure messaging: patientcare@mehop.org

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Tisha Zalman Individual W-2 Managing EmployeeCfo Jul 1, 2021
Nan Harrison Individual W-2 Managing EmployeeCeo Jul 13, 2008

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1185840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736985600000",
    "number": "1073703575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 AVENUE F N",
            "city": "BAY CITY",
            "state": "TX",
            "postal_code": "774143167",
            "telephone_number": "979-245-2008",
            "fax_number": "979-245-0744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 IDA AVE",
            "city": "BAY CITY",
            "state": "TX",
            "postal_code": "774143167",
            "telephone_number": "979-245-2008",
            "fax_number": "979-245-0242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATAGORDA EPISCOPAL HEALTH OUTREACH PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-31",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "CELESTE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "979-245-2008"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "TX",
            "license": "671914",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "347977601",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Patientcare@mehop.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "101 Avenue F N",
            "city": "Bay City",
            "state": "TX",
            "country_code": "US",
            "postal_code": "774143167",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "credentialing@mehop.org",
            "affiliation": "N",
            "endpointDescription": "credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "101 Avenue F N",
            "city": "Bay City",
            "state": "TX",
            "country_code": "US",
            "postal_code": "774143167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Vibrance Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MEHOP Oral Health Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "MEHOP Oral Health Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bay City, TX

Sources for this page

Verify at the official NPI Registry.