NPIMap

Organization Active NPI

Coastal Bend Wellness Foundation Inc

  • Federally Qualified Health Center (FQHC)
  • Corpus Christi, TX
National Provider Identifier
1144523671
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COASTAL BEND WELLNESS FOUNDATION INC
Practice address
2882 Holly Rd.
Corpus Christi, TX 78415
Phone
(361) 814-2001
Fax
(361) 883-1998
NPI assigned
Dec 6, 2010
Last updated
Jun 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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

Authorized official

Name
Mr. Bill Jeron Hoelscher
Title
Ceo
Phone
(361) 814-2001

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

2882 Holly Rd.
Corpus Christi, TX 78415

Mailing address

5633 S Staples St Ste 700
Corpus Christi, TX 78411-4679
Phone (361) 814-2001

Other practice location 1

5633 S Staples St
Suite 700
Corpus Christi, TX 78411-4646
Phone (361) 814-2001

Other practice location 2

5633 S Staples St
Suite 700
Corpus Christi, TX 78411-4646
Phone (361) 814-2001

Other identifiers 1

IdentifierTypeStateIssuer
291803903MedicaidTX

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150106000127 TX Part B Supplier - Clinic/Group Practice 9931422649 Receives reassigned benefits from 17 practitioners
Practice locations: Corpus Christi, TX
O20160203000362 TX Part A Provider - Federally Qualified Health Center (FQHC) 9931422649 Practice locations: Corpus Christi, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144523671. Details of each certification follow.

Federally qualified health center certification: CCN 741921

Legal name
COASTAL BEND WELLNESS FOUNDATION INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 3, 2016
Last certification
Feb 3, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 27, 1986 in TX
Enrollment address
2882 Holly Rd
Corpus Christi, TX 78415-4106

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Coastal Bend Wellness4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Bill Jeron Hoelscher Individual 5% Or Greater Direct Ownership InterestCeo Mar 15, 2011 100%
W-2 Managing EmployeeCeo Mar 15, 2011 100%

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Coastal Bend Wellness Foundation IncKingsville, TX, CCN 671144 Federally qualified health center Operational/Managerial Control Jun 1, 2021

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 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1291593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1144523671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5633 S STAPLES ST STE 700",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784114679",
            "telephone_number": "361-814-2001",
            "fax_number": "361-883-1998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2882 HOLLY RD.",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "78415",
            "telephone_number": "361-814-2001",
            "fax_number": "361-883-1998"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5633 S Staples St",
            "address_2": "Suite 700",
            "address_purpose": "LOCATION",
            "city": "Corpus Christi",
            "state": "TX",
            "postal_code": "784114646",
            "country_code": "US",
            "telephone_number": "361-814-2001",
            "fax_number": "361-883-1998",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5633 S Staples St",
            "address_2": "Suite 700",
            "address_purpose": "LOCATION",
            "city": "Corpus Christi",
            "state": "TX",
            "postal_code": "784114646",
            "country_code": "US",
            "telephone_number": "361-814-2001",
            "fax_number": "361-883-1998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COASTAL BEND WELLNESS FOUNDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-06",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "HOELSCHER",
        "authorized_official_first_name": "BILL",
        "authorized_official_middle_name": "JERON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "361-814-2001",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291803903",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Corpus Christi, TX

Sources for this page

Verify at the official NPI Registry.