NPIMap

Organization Active NPI

St Hope Foundation Inc

  • Federally Qualified Health Center (FQHC)
  • Conroe, TX
National Provider Identifier
1265581144
Registry record updated May 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ST HOPE FOUNDATION INC
Practice address
1414 S Frazier St
Suite 106
Conroe, TX 77301-4453
Phone
(936) 441-2440
Fax
(800) 249-5020
NPI assigned
Jan 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2021

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

Authorized official

Name
Mr. Rodney Neil Goodie Jr.
Title
Ceo
Phone
(713) 778-1300

Specialties & licenses 1

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

Addresses

Primary practice location

1414 S Frazier St
Suite 106
Conroe, TX 77301-4453

Mailing address

6200 Savoy Drive
Suite 540
Houston, TX 77036-3338
Phone (713) 778-1300

Other identifiers 2

IdentifierTypeStateIssuer
1567299-03MedicaidTX
0021KKOtherTXBLUE CROSS/BLUE SHIELD

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000896 TX Part B Supplier - Clinic/Group Practice 4880508878 Receives reassigned benefits from 19 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sugar Land, TX; Conroe, TX; Jersey Village, TX; Houston, TX; Dickinson, TX; Bellaire, TX
O20170905000734 TX Part A Provider - Federally Qualified Health Center (FQHC) 4880508878 Practice locations: Conroe, TX

Federally qualified health center certification: CCN 741966

Legal name
ST. HOPE FOUNDATION INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 5, 2017
Last certification
Sep 5, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 3, 1999 in TX
Enrollment address
1414 S Frazier St
Ste 105
Conroe, TX 77301-4475

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
St Hope Pharmacy16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

1414 S Frazier St
Ste 105106
Conroe, TX 77301
Phone (936) 441-2440

1414 S Frazier St
Ste 106
Conroe, TX 77301
Phone (936) 441-2440

20320 Northwest Fwy
Ste 500
Jersey Village, TX 77065
Phone (281) 453-7110

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
Rodney Goodie Individual Corporate OfficerCeo Nov 4, 1997 100%
Operational/Managerial ControlCeo Jul 1, 2016 100%
Tabitha Williams-McLenon Individual Corporate Director Aug 21, 2017 0.01%
Timika R Sam Cooper Individual Corporate OfficerCoo Jul 1, 2016 100%
W-2 Managing EmployeeCoo Jul 1, 2016 100%
Operational/Managerial ControlCoo Jul 1, 2016 100%
St. Hope Foundation Inc Organization, Houston, TX Corporation, Non-profit Operational/Managerial Control Jul 1, 2016 100%

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St. Hope Foundation IncHouston, TX, CCN 741842 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
5% Or Greater Security Interest (100%)		 Nov 1, 2013
Nov 1, 2013
St. Hope Foundation IncSugar Land, TX, CCN 741968 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2016
St. Hope Foundation IncJersey Village, TX, CCN 451178 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
5% Or Greater Security Interest (100%)		 Nov 24, 2021
Nov 24, 2021

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621382400000",
    "number": "1265581144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 SAVOY DRIVE",
            "address_2": "SUITE 540",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770363338",
            "telephone_number": "713-778-1300",
            "fax_number": "713-778-0827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 S FRAZIER ST",
            "address_2": "SUITE 106",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773014453",
            "telephone_number": "936-441-2440",
            "fax_number": "800-249-5020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST HOPE FOUNDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A",
        "authorized_official_last_name": "GOODIE",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "NEIL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "713-778-1300",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1567299-03",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "0021KK",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

Verify at the official NPI Registry.