NPIMap

Organization Active NPI

Health Center of Southeast Texas

Doing business as Health Center of Southeast Texas-Shepherd

  • Federally Qualified Health Center (FQHC)
  • Cleveland, TX
National Provider Identifier
1225059686
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEALTH CENTER OF SOUTHEAST TEXAS
Doing business as
Health Center of Southeast Texas-Shepherd
Practice address
307 N William Barnett Ave
Cleveland, TX 77327-4061
Phone
(281) 592-2224
Fax
(281) 592-2225
NPI assigned
Jul 21, 2006
Last updated
Oct 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Authorized official

Name
Mr. Steven Racciato, MSHA
Title
Executive Director
Phone
(281) 592-2224

Specialties & licenses 1

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

Addresses

Primary practice location

307 N William Barnett Ave
Cleveland, TX 77327-4061

Mailing address

307 N William Barnett Ave
Cleveland, TX 77327-4061
Phone (281) 592-2224

Other identifiers 4

IdentifierTypeStateIssuer
179566801MedicaidTX
179566802MedicaidTX
179566803MedicaidTX
0044NHOtherTXBLUE CROSS/S GROUP NUMBER

Other names 1

  • Health Center of Southeast Texas-Shepherd Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060223000543 TX Part B Supplier - Clinic/Group Practice 9739195041 Receives reassigned benefits from 22 practitioners
5 other NPIs on this enrollment
Practice locations: Cleveland, TX; Shepherd, TX; Livingston, TX; Liberty, TX; Dayton, TX
O20071023000681 TX Part A Provider - Federally Qualified Health Center (FQHC) 9739195041 Practice locations: Cleveland, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225059686. Details of each certification follow.

Federally qualified health center certification: CCN 671866

Legal name
HEALTH CENTER OF SOUTHEAST TEXAS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 30, 2007
Last certification
Nov 30, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 14, 2005 in TX
Enrollment address
307 N William Barnett Ave
Cleveland, TX 77327-4061

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

871 County Road 3549
Cleveland, TX 77327
Phone (281) 592-2224

204 W Park
Ste 100
Livingston, TX 77352

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Susan Bailes Individual Corporate DirectorBoard Member Jan 1, 2016
Ilona Molton Individual Corporate DirectorVice Chairman of the Board Jan 1, 2016
Walter Scott Lambert Individual Corporate DirectorBoard Member Feb 1, 2024
Jennifer L Bergman Individual Corporate DirectorBoard Member Jan 14, 2016
Sherrell Wolfe Individual Corporate DirectorBoard Member Jul 18, 2013
Amalia Reddell Individual Corporate DirectorBoard Member Feb 13, 2008
Eisha Jones Individual Corporate DirectorBoard Member Feb 11, 2016
Andee Kesner Individual Corporate OfficerChief Operating Office May 4, 2026
Corporate DirectorChief Operating Office May 4, 2026
W-2 Managing EmployeeChief Operating Office May 4, 2026
Amanda Brooks Individual Corporate DirectorBoard Member Jun 1, 2022
Magdalena Estrada Individual Corporate OfficerChief Executive Officer May 4, 2026
Corporate DirectorChief Executive Officer May 4, 2026
W-2 Managing EmployeeChief Executive Officer May 4, 2026
Kari Rhodes Individual Corporate DirectorBoard Member Oct 13, 2022
James Smith Individual Corporate Director Sep 12, 2019

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604016000000",
    "number": "1225059686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 N WILLIAM BARNETT AVE",
            "city": "CLEVELAND",
            "state": "TX",
            "postal_code": "773274061",
            "telephone_number": "281-592-2224",
            "fax_number": "281-592-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 N WILLIAM BARNETT AVE",
            "city": "CLEVELAND",
            "state": "TX",
            "postal_code": "773274061",
            "telephone_number": "281-592-2224",
            "fax_number": "281-592-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH CENTER OF SOUTHEAST TEXAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A",
        "authorized_official_last_name": "RACCIATO",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "281-592-2224",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSHA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179566801",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179566802",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179566803",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/S GROUP NUMBER",
            "identifier": "0044NH",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Center of Southeast Texas-Shepherd",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cleveland, TX

Sources for this page

Verify at the official NPI Registry.