NPIMap

Organization Active NPI

Stephen F Austin Community Health Center, Inc

Doing business as MyCHN Silverlake

  • Federally Qualified Health Center (FQHC)
  • Pearland, TX
National Provider Identifier
1255087938
Registry record updated Feb 20, 2025
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
Doing business as
MyCHN Silverlake
Practice address
9430 Broadway St Ste 120
Pearland, TX 77584-8075
Phone
(281) 824-1480
Fax
(281) 220-6407
NPI assigned
Feb 22, 2022
Last updated
Feb 20, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Multi-Specialty Clinic/Center 261QM1300X NU

Addresses

Primary practice location

9430 Broadway St Ste 120
Pearland, TX 77584-8075

Mailing address

1111 W Adoue St
Alvin, TX 77511-2718
Phone (281) 824-1480

Other names 1

  • MyCHN Silverlake Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230315002368 TX Part A Provider - Federally Qualified Health Center (FQHC) 6204977127 Practice locations: Pearland, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255087938. Details of each certification follow.

Federally qualified health center certification: CCN 451866

Legal name
STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC.
Doing business as
MYCHN SILVERLAKE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 17, 2023
Last certification
Jan 17, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 14, 2008 in TX
Enrollment address
9430 Broadway St
Ste 120
Pearland, TX 77584-8075

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
45D2259008Mychn Silverlake9430 Broadway St, Ste 120, Pearland, TX 77584Certificate of waiverApr 28, 2028

National Provider Directory

National Provider Directory
Tax ID family
CHN Pharmacy28 organizations share this tax ID, including this one
Part of
CHN Pharmacy

Other organizations with this tax ID 27

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

View all 27

Ownership & related parties

All disclosed owners & managing parties 7

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 II Apr 7, 2016
Mark Young Individual 5% Or Greater Indirect Ownership InterestCeo Apr 1, 2010
Corporate OfficerCeo Apr 1, 2010
Corporate DirectorCeo Apr 1, 2010
Debra Fontenot Individual Corporate DirectorBoard Member Aug 21, 2018
Bonnie Horton Individual Corporate DirectorBoard Member Apr 8, 2008
Gerald Roznovsky Individual Corporate DirectorBoard Member- Chairman of the Board Apr 8, 2008
Gina Adams Individual Corporate DirectorBoard Member-Vice Chairman Jan 1, 2015

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.

NPI Registry JSON

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

{
    "created_epoch": "1645488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740009600000",
    "number": "1255087938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 W ADOUE ST",
            "city": "ALVIN",
            "state": "TX",
            "postal_code": "775112718",
            "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": "9430 BROADWAY ST STE 120",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775848075",
            "telephone_number": "281-824-1480",
            "fax_number": "281-220-6407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC",
        "enumeration_date": "2022-02-22",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "281-824-1480"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MyCHN Silverlake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pearland, TX

Sources for this page

Verify at the official NPI Registry.