NPIMap

Organization Active NPI

Tejas Health Care

  • Federally Qualified Health Center (FQHC)
  • La Grange, TX
National Provider Identifier
1073779500
Registry record updated May 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TEJAS HEALTH CARE
Practice address
890 E Travis St
La Grange, TX 78945-2364
Phone
(979) 968-2000
Fax
(979) 968-2001
NPI assigned
Aug 4, 2008
Last updated
May 7, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2019

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

Authorized official

Name
Pamela Wyant
Title
Billing Supervisor
Phone
(979) 968-2000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

890 E Travis St
La Grange, TX 78945-2364

Mailing address

753 E Travis St
La Grange, TX 78945-2353
Phone (979) 968-2000

Other identifiers 3

IdentifierTypeStateIssuer
202580110MedicaidTX
202580104MedicaidTX
202580107MedicaidTX

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090526000409 TX Part B Supplier - Clinic/Group Practice 1153470067 Receives reassigned benefits from 21 practitioners
1 other NPI on this enrollment
Practice locations: La Grange, TX; Giddings, TX
O20100414000885 TX Part A Provider - Federally Qualified Health Center (FQHC) 1153470067 Practice locations: La Grange, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073779500. Details of each certification follow.

Federally qualified health center certification: CCN 671942

Legal name
TEJAS HEALTH CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 19, 2010
Last certification
May 19, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 14, 2007 in TX
Enrollment address
890 E Travis St
La Grange, TX 78945-2364

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

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
45D2001397Tejas Health Care890 E Travis St, La Grange, TX 78945Certificate of waiverMay 31, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Tejas Health Care Organization, La Grange, TX Non-profit Operational/Managerial Control May 19, 2010
Sheri Kehler Individual Corporate OfficerCeo May 5, 2014
W-2 Managing EmployeeCeo May 5, 2014 80%
Jackie Daniels Individual Corporate DirectorSecretary Oct 1, 2014
Jon-New Perez Individual Corporate DirectorDirector Dec 1, 2022
Pamela Wyant Individual W-2 Managing EmployeeBilling Supervisor Apr 15, 2013
Arnold Romberg Individual Corporate DirectorDirector Jan 1, 2016
Randy Albers Individual Corporate DirectorVice President Jan 4, 2016
Linda King Individual Corporate DirectorDirector Jan 1, 2017
Cathy Horn Individual Corporate DirectorDirector Sep 21, 2011
Leticia Villalobos Individual Corporate DirectorDirector Jan 1, 2017
William H Bailey Individual Corporate DirectorDirector Jan 1, 2017
Karey Bresenhan Individual Corporate DirectorDirector Jun 1, 2015
Don Jones Individual Corporate DirectorTreasurer Jan 1, 2015

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tejas Health CareGiddings, TX, CCN 741889 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 19, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557187200000",
    "number": "1073779500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "753 E TRAVIS ST",
            "city": "LA GRANGE",
            "state": "TX",
            "postal_code": "789452353",
            "telephone_number": "979-968-2000",
            "fax_number": "979-968-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 E TRAVIS ST",
            "city": "LA GRANGE",
            "state": "TX",
            "postal_code": "789452364",
            "telephone_number": "979-968-2000",
            "fax_number": "979-968-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEJAS HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-04",
        "last_updated": "2019-05-07",
        "status": "A",
        "authorized_official_last_name": "WYANT",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "979-968-2000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202580110",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202580104",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202580107",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grange, TX

Sources for this page

Verify at the official NPI Registry.