NPIMap

Organization Active NPI

Health Center of Southeast Texas

Doing business as Health Center of Southeast Texas - Terrenos

  • Federally Qualified Health Center (FQHC)
  • Cleveland, TX
National Provider Identifier
1265197867
Registry record updated Jun 21, 2023
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 - Terrenos
Practice address
871 CR 3549
Cleveland, TX 77327
Phone
(281) 592-2224
NPI assigned
Nov 8, 2021
Last updated
Jun 21, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
HEALTH CENTER OF SOUTHEAST TEXASAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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

Authorized official

Name
Steven Racciato
Title
Ceo
Phone
(281) 592-2224

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Nurse Practitioner 363LF0000X
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

871 CR 3549
Cleveland, TX 77327

Mailing address

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

Other names 1

  • Health Center of Southeast Texas - Terrenos 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
This NPI is an additional NPI on the enrollment
Practice locations: Cleveland, TX; Shepherd, TX; Livingston, TX; Liberty, TX; Dayton, TX
O20220321001492 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 1265197867. Details of each certification follow.

Federally qualified health center certification: CCN 451183

Legal name
HEALTH CENTER OF SOUTHEAST TEXAS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 28, 2022
Last certification
Mar 28, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 14, 2005 in TX
Enrollment address
871 County Road 3549
Cleveland, TX 77327

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
Tax ID family
Health Center of Southeast6 organizations share this tax ID, including this one
Part of
Health Center of Southeast

Other organizations with this tax ID 5

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

Locations

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

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
Susan Bailes Individual Corporate DirectorChairman of the Board Jan 1, 2016
Audrey Burkett Individual Corporate Director May 14, 2020
Clarence Burkett Individual Corporate Director May 14, 2020
Ilona Molton Individual Corporate DirectorVice Chairman of the Board Jan 1, 2016
Jennifer L Bergman Individual Corporate Director Jan 14, 2016
Sherrell Wolfe Individual Corporate Director Jan 1, 2013
Amalia Reddell Individual Corporate Director Nov 18, 2009
Eisha Jones Individual Corporate DirectorTreasurer Feb 11, 2016
Andee Kesner Individual Corporate OfficerChief Operating Officer May 4, 2026
Corporate DirectorChief Executive Officer May 4, 2026
W-2 Managing EmployeeChief Operating Officer May 4, 2026
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
James Smith Individual Corporate DirectorSecretary Sep 12, 2019

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1636329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687305600000",
    "number": "1265197867",
    "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": "871 CR 3549",
            "city": "CLEVELAND",
            "state": "TX",
            "postal_code": "77327",
            "telephone_number": "281-592-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH CENTER OF SOUTHEAST TEXAS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEALTH CENTER OF SOUTHEAST TEXAS",
        "enumeration_date": "2021-11-08",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A",
        "authorized_official_last_name": "RACCIATO",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "281-592-2224"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Center of Southeast Texas - Terrenos",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Health Center of Southeast Texas - Terrenos",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cleveland, TX

Sources for this page

Verify at the official NPI Registry.