NPIMap

Organization Active NPI

Midland Community Healthcare Services

  • Federally Qualified Health Center (FQHC)
  • Midland, TX
National Provider Identifier
1235225087
Registry record updated Jun 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MIDLAND COMMUNITY HEALTHCARE SERVICES
Practice address
801 E Florida Ave
Midland, TX 79701-8212
Phone
(432) 685-0450
Fax
(432) 685-0459
NPI assigned
Oct 5, 2006
Last updated
Jun 3, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MIDLAND COMMUNITY HEALTHCARE SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 3, 2021

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

Authorized official

Name
Mr. Michael Austin, PHD
Title
Ceo
Phone
(432) 570-0238

Specialties & licenses 1

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

Addresses

Primary practice location

801 E Florida Ave
Midland, TX 79701-8212

Mailing address

PO Box 5576
Midland, TX 79704-5576
Phone (432) 570-0238

Other identifiers 2

IdentifierTypeStateIssuer
0090KVOtherTXBLUE CROSS BLUE SHIELD
165581305MedicaidTX

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040515000364 TX Part B Supplier - Clinic/Group Practice 0345230975 Receives reassigned benefits from 32 practitioners
Practice locations: Midland, TX
O20050404000969 TX Part A Provider - Federally Qualified Health Center (FQHC) 0345230975 Practice locations: Midland, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235225087. Details of each certification follow.

Federally qualified health center certification: CCN 671816

Legal name
MIDLAND COMMUNITY HEALTHCARE SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 7, 2005
Last certification
Apr 7, 2005
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 23, 2003 in TX
Enrollment address
801 E Florida Ave
Midland, TX 79701-8212

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Part of
Midland Comm Hlthcare SVCS

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Lydia Frescaz Individual Corporate OfficerBoard Member Jan 1, 2014
Virgina Davis Individual Corporate OfficerBoard Member May 1, 2020
Jake Flader Individual Corporate OfficerBoard Member Jan 1, 2014
Michael Austin Individual Corporate DirectorCeo Mar 17, 2009
W-2 Managing Employee Mar 17, 2009

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622678400000",
    "number": "1235225087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5576",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797045576",
            "telephone_number": "432-570-0238",
            "fax_number": "432-699-3815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E FLORIDA AVE",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797018212",
            "telephone_number": "432-685-0450",
            "fax_number": "432-685-0459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDLAND COMMUNITY HEALTHCARE SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIDLAND COMMUNITY HEALTHCARE SERVICES",
        "enumeration_date": "2006-10-05",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A",
        "authorized_official_last_name": "AUSTIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "432-570-0238",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0090KV",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165581305",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, TX

Sources for this page

Verify at the official NPI Registry.