NPIMap

Organization Active NPI

Amistad Community Health Center Incorporated

Doing business as Amistad Health

  • Federally Qualified Health Center (FQHC)
  • Robstown, TX
National Provider Identifier
1114725231
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
AMISTAD COMMUNITY HEALTH CENTER INCORPORATED
Doing business as
Amistad Health
Practice address
710 E Main Ave
Robstown, TX 78380-3133
Phone
(361) 884-2242
Fax
(361) 884-2243
NPI assigned
Mar 4, 2025
Last updated
Apr 3, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
AMISTAD COMMUNITY HEALTH CENTER INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Authorized official

Name
Clara Talia Peterson
Title
Cfo
Phone
(361) 886-3066

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

710 E Main Ave
Robstown, TX 78380-3133

Mailing address

1533 S Brownlee Blvd
Corpus Christi, TX 78404-3131
Phone (361) 884-2242

Other names 1

  • Amistad Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250417002668 TX Part A Provider - Federally Qualified Health Center (FQHC) 8527131036 Practice locations: Robstown, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114725231. Details of each certification follow.

Federally qualified health center certification: CCN 971064

Legal name
AMISTAD COMMUNITY HEALTH CENTER INCORPORATED
Doing business as
AMISTAD HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 13, 2025
Last certification
May 13, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
710 E Main Ave
Robstown, TX 78380-3133

Other NPIs with the same Medicare PAC ID 6

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
45D2327937Amistad Community Health Center Inc710 E Main Ave, Robstown, TX 78380Certificate of waiverJul 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Amistad Comm HLTH Ctr Inc8 organizations share this tax ID, including this one
Part of
Amistad Comm HLTH Ctr Inc

Other organizations with this tax ID 7

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

Locations

1533 S Brownlee Blvd
Corpus Christi, TX 78404
Phone (361) 884-2242

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
Tamiko Richardson Individual W-2 Managing EmployeeRevenue and Compliance Coordinator Mar 6, 2025
Other Mar 6, 2025
Eric Baggerman Individual W-2 Managing Employee Mar 6, 2025
OtherCeo Mar 6, 2025

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 2

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

FacilityTypeRoleSince
Rcm360 LLCRobstown, TX, CCN 451103 Federally qualified health center Operational/Managerial Control Jan 1, 2020
Amistad Community Health Center IncorporatedAransas Pass, TX, CCN 451164 Federally qualified health center Operational/Managerial Control Nov 1, 2021

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1741046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743638400000",
    "number": "1114725231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1533 S BROWNLEE BLVD",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784043131",
            "telephone_number": "361-884-2242",
            "fax_number": "361-884-2243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 E MAIN AVE",
            "city": "ROBSTOWN",
            "state": "TX",
            "postal_code": "783803133",
            "telephone_number": "361-884-2242",
            "fax_number": "361-884-2243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMISTAD COMMUNITY HEALTH CENTER INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMISTAD COMMUNITY HEALTH CENTER INCORPORATED",
        "enumeration_date": "2025-03-04",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "CLARA",
        "authorized_official_middle_name": "TALIA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "361-886-3066"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Amistad Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Amistad Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Robstown, TX

Sources for this page

Verify at the official NPI Registry.