NPIMap

Organization Active NPI

El Centro de Corazon

  • Federally Qualified Health Center (FQHC)
  • Houston, TX
National Provider Identifier
1245556885
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EL CENTRO DE CORAZON
Practice address
7635 Canal St.
Houston, TX 77012-1143
Phone
(713) 660-1880
Fax
(713) 926-9105
NPI assigned
Apr 7, 2010
Last updated
Dec 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

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

Authorized official

Name
Ms. Marcelle Elizabeth Mir, MSW
Title
Ceo
Phone
(713) 660-1880

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X
Community Health WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 172V00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

7635 Canal St.
Houston, TX 77012-1143

Mailing address

P.O. Box 230209
Houston, TX 77223
Phone (713) 660-1880

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130619000168 TX Part A Provider - Federally Qualified Health Center (FQHC) 0345216214 Practice locations: Houston, TX
O20240122002645 TX Part B Supplier - Clinic/Group Practice 0345216214 Receives reassigned benefits from 30 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Houston, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245556885. Details of each certification follow.

Federally qualified health center certification: CCN 741820

Legal name
EL CENTRO DE CORAZON
Doing business as
EL CENTRO DE CORAZON CLINICA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 2013
Last certification
Jul 1, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 23, 1994 in TX
Enrollment address
7635 Canal St
Houston, TX 77012-1143

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Kavon Lynette Young Individual Corporate OfficerChief Medical Officer Mar 15, 2013
W-2 Managing EmployeeChief Medical Officer Mar 15, 2013
Carol Paret Individual Corporate DirectorBoard Member Jan 22, 2014
Maria Pereyra-Gonzalez Individual Corporate DirectorBoard Member Aug 18, 2010
Shannon Hart Individual Corporate Director Mar 12, 2012
Marcelle Mir Individual Corporate OfficerCeo Sep 1, 1998
W-2 Managing EmployeeCeo Jun 1, 2012 80%
Paulina Putman Individual Corporate OfficerCfo Dec 15, 2015
W-2 Managing EmployeeCfo Dec 15, 2015
Melissa Fisher Individual Corporate OfficerTreasurer-Board of Directors Jul 26, 2017
Michael Hinojosa Individual Corporate DirectorBoard Member Apr 25, 2018
Joel Shannon Individual Corporate DirectorVice Chair-Board of Directors Aug 18, 2010
Pamela Tyner Individual Corporate DirectorBoard Secretary-Board of Directo Jul 24, 2013
Guadalupe Olivarez Individual Corporate DirectorBoard Member Jul 28, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1270598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734048000000",
    "number": "1245556885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 230209",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77223",
            "telephone_number": "713-660-1880",
            "fax_number": "713-926-9105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7635 CANAL ST.",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770121143",
            "telephone_number": "713-660-1880",
            "fax_number": "713-926-9105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL CENTRO DE CORAZON",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-07",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A",
        "authorized_official_last_name": "MIR",
        "authorized_official_first_name": "MARCELLE",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "713-660-1880",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "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": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.