NPIMap

Organization Active NPI

Stephen F Austin Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Angleton, TX
National Provider Identifier
1154967776
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC
Practice address
2020 E Mulberry St
Angleton, TX 77515-3923
Phone
(281) 824-1480
Fax
(281) 220-6407
NPI assigned
Nov 19, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Authorized official

Name
Brandy Smith
Title
Credentialing Coordinator
Phone
(281) 824-1480

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2020 E Mulberry St
Angleton, TX 77515-3923

Mailing address

2020 E Mulberry St
Angleton, TX 77515-3923
Phone (281) 824-1480

Other names 1

  • Angleton Internal Medicine and Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200720001056 TX Part A Provider - Federally Qualified Health Center (FQHC) 6204977127 Practice locations: Angleton, TX

Federally qualified health center certification: CCN 451119

Legal name
STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC.
Doing business as
ANGLETON INTERNAL MEDICINE AND PRIMARY CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 16, 2020
Last certification
Jul 16, 2020
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jan 1, 2020 in TX
Enrollment address
2020 E Mulberry St
Angleton, TX 77515-3923

Other NPIs with the same Medicare PAC ID 14

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

View all 14

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
45D0713812Angleton Internal Medicine & Primary Care2020 East Mulberry Road, Angleton, TX 77515Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
CHN Pharmacy25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Marbella Hooper Individual Corporate DirectorBoard Member Secretary Aug 1, 2017
Brandy Smith Individual W-2 Managing EmployeeCredentialing Coordinator Apr 7, 2016
Mark Young Individual 5% Or Greater Direct Ownership InterestCeo Apr 1, 2010 100%
Corporate OfficerCeo Apr 1, 2010 100%
Corporate DirectorCeo Apr 1, 2010
Debra Fontenot Individual Corporate DirectorBoard Member Aug 21, 2018
Ronald Medina Individual Corporate DirectorBoard Member Oct 20, 2015
Bonnie Horton Individual Corporate DirectorBoard Member Apr 8, 2008
Gerald Roznovsky Individual Corporate DirectorBoard Member, Chairman Apr 8, 2008
Gina Adams Individual Corporate DirectorBoard Member Vice Chair Apr 8, 2008

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Stephen F Austin Community Health Center, Inc.Alvin, TX, CCN 671934 Federally qualified health center Operational/Managerial Control Nov 24, 2009
Mychn CallawayAlvin, TX, CCN 741976 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2017
Women and Children'S Health CenterAlvin, TX, CCN 451000 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 3, 2016
Pearland Family Health CenterPearland, TX, CCN 451039 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 9, 2018
Mychn WebsterWebster, TX, CCN 971091 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 16, 2017

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1574121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1154967776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 E MULBERRY ST",
            "city": "ANGLETON",
            "state": "TX",
            "postal_code": "775153923",
            "telephone_number": "281-824-1480",
            "fax_number": "281-220-6407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 E MULBERRY ST",
            "city": "ANGLETON",
            "state": "TX",
            "postal_code": "775153923",
            "telephone_number": "281-824-1480",
            "fax_number": "281-220-6407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-19",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "281-824-1480"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Angleton Internal Medicine and Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Angleton, TX

Sources for this page

Verify at the official NPI Registry.