NPIMap

Organization Active NPI

El Centro del Barrio Inc

Doing business as CentroMed Southside Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • San Antonio, TX
National Provider Identifier
1104998749
Registry record updated Aug 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
HBOCS00758-04-00 Issued in TX
Legal business name
EL CENTRO DEL BARRIO INC
Doing business as
CentroMed Southside Medical Clinic
Practice address
3750 Commercial Ave
San Antonio, TX 78221-3117
Phone
(210) 334-3700
Fax
(210) 922-0162
NPI assigned
Nov 15, 2006
Last updated
Aug 18, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2011

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

Authorized official

Name
Chuck Walzel
Title
Cfo
Phone
(210) 334-3724

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X HBOCS007758-04-00 TX
Federally Qualified Health Center (FQHC) 261QF0400X HBOCS00758-04-00 TX Primary

Addresses

Primary practice location

3750 Commercial Ave
San Antonio, TX 78221-3117

Mailing address

3750 Commercial Ave
San Antonio, TX 78221-3117
Phone (210) 334-3700

Other names 1

  • CentroMed Southside Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050303000520 TX Part A Provider - Federally Qualified Health Center (FQHC) 6800881285 Practice locations: San Antonio, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104998749. Details of each certification follow.

Federally qualified health center certification: CCN 671800

Legal name
EL CENTRO DEL BARRIO INC
Doing business as
CENTROMED SOUTHSIDE MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 22, 2005
Last certification
Mar 22, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 14, 1973 in TX
Enrollment address
3750 Commercial Ave
San Antonio, TX 78221-3117
Related CCNs
451831

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

Other NPIs with the same Medicare PAC ID 20

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

View all 20

National Provider Directory

National Provider Directory
Tax ID family
Centro del Barrio Inc37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Melinda Perez Individual Corporate DirectorBoard Member Jan 28, 2021
Donald J Macaulay Individual W-2 Managing EmployeeVP/Coo Feb 20, 1995
Ricardo Perez Individual Corporate DirectorBoard Member Mar 19, 2009
Diana M Torres Individual Corporate DirectorBoard Member Jun 30, 1994
Elsa Gambo Individual Corporate DirectorBoard Member Jan 23, 2020
Juan a Chavira Individual Corporate DirectorBoard Member May 22, 2006
Rudy Pena Individual Corporate DirectorBoard Member Sep 1, 2011
Noemi G Eling Individual Corporate DirectorBoard Member Feb 27, 1992
Heriberto Guerra Individual Corporate DirectorBoard Member Jan 28, 1999
Luz M Cano Individual Corporate DirectorBoard Member Apr 2, 2015
Lawrence Charles Walzel Individual Corporate OfficerVP/Cfo Feb 16, 1998
W-2 Managing EmployeeVP/Cfo Feb 16, 1998
Norma L Green Individual Corporate DirectorBoard Member Jun 27, 1991
Ernesto Gomez Individual Corporate DirectorPresident & Chief Executive Officer Jun 1, 1973
W-2 Managing EmployeePresident & Chief Executive Officer Jun 1, 1973
Arlene James Brown Individual Corporate DirectorBoard Member Mar 14, 2019
Lorraine Alaniz Individual Corporate DirectorBoard Member Jun 24, 2021
Elsa I Martinez Individual Corporate DirectorBoard Member Jun 16, 2014

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Centromed City Center ClinicSan Antonio, TX, CCN 451166 Federally qualified health center Operational/Managerial Control Jan 3, 2022

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 10

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": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313625600000",
    "number": "1104998749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3750 COMMERCIAL AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782213117",
            "telephone_number": "210-334-3700",
            "fax_number": "210-922-0162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 COMMERCIAL AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782213117",
            "telephone_number": "210-334-3700",
            "fax_number": "210-922-0162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL CENTRO DEL BARRIO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2011-08-18",
        "status": "A",
        "authorized_official_last_name": "WALZEL",
        "authorized_official_first_name": "CHUCK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "210-334-3724"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "HBOCS007758-04-00",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "TX",
            "license": "HBOCS00758-04-00",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CentroMed Southside Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.