NPIMap

Organization Active NPI

Navarro County Ambulatory Care Association

  • Federally Qualified Health Center (FQHC)
  • Corsicana, TX
National Provider Identifier
1124782875
Registry record updated Feb 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NAVARRO COUNTY AMBULATORY CARE ASSOCIATION
Practice address
618 N Main St
Corsicana, TX 75110-3028
Phone
(903) 874-6731
NPI assigned
Oct 28, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2025

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

Authorized official

Name
Marty R. Summerall
Title
Ceo
Phone
(903) 851-0727

Specialties & licenses 1

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

Addresses

Primary practice location

618 N Main St
Corsicana, TX 75110-3028

Mailing address

618 N Main St
Corsicana, TX 75110-3028
Phone (903) 851-7031

Other names 2

  • Dr Kent E. Rogers Clinic Doing business as
  • Navarro County Ambulatory Care Association Former legal business name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230412002904 TX Part B Supplier - Clinic/Group Practice 2466827035 Receives reassigned benefits from 4 practitioners
Practice locations: Corsicana, TX
O20250506000351 TX Part A Provider - Federally Qualified Health Center (FQHC) 2466827035 Practice locations: Corsicana, TX

Federally qualified health center certification: CCN 971063

Legal name
NAVARRO COUNTY AMBULATORY CARE ASSOCIATION
Doing business as
DR KENT E. ROGERS CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 6, 2025
Last certification
May 6, 2025
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
618 N Main St
Ste B
Corsicana, TX 75110-3028

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
45D2285602Navarro County Ambulatory Care Association618 North Main Street, Corsicana, TX 75110Certificate of waiverJul 13, 2027

National Provider Directory

National Provider Directory

Locations

618 N Main St
#B
Corsicana, TX 75110
Phone (903) 874-6731

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Mitchell Guivehchi Individual W-2 Managing EmployeeCredentialing Manager Apr 1, 2025
Marty Summerall Individual W-2 Managing EmployeeAd; Feb 1, 2025
Maria T Lemus Individual W-2 Managing EmployeeComptroller Feb 1, 2025

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1635379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739318400000",
    "number": "1124782875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "618 N MAIN ST",
            "city": "CORSICANA",
            "state": "TX",
            "postal_code": "751103028",
            "telephone_number": "903-851-7031",
            "fax_number": "903-872-7215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 N MAIN ST",
            "city": "CORSICANA",
            "state": "TX",
            "postal_code": "751103028",
            "telephone_number": "903-874-6731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NAVARRO COUNTY AMBULATORY CARE ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-28",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A",
        "authorized_official_last_name": "SUMMERALL",
        "authorized_official_first_name": "MARTY",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "903-851-0727"
    },
    "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": "Dr Kent E. Rogers Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Navarro County Ambulatory Care Association",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Corsicana, TX

Sources for this page

Verify at the official NPI Registry.