Heart of Texas Community Health Center, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · MC Gregor, TX
NPI 1306166830 · NPPES record last updated Jul 28, 2017
Key facts
- NPI
- 1306166830
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- HEART OF TEXAS COMMUNITY HEALTH CENTER, INC
- Practice address
- 500 Johnson Dr
MC Gregor, TX 76657-1441 - Phone
- (254) 313-5200
- Fax
- (254) 313-5299
- NPI assigned
- Jun 7, 2010
- Organization subpart
- No
Authorized official
- Name
- Annette Ballew, CPA
- Title
- Cfo
- Phone
- (254) 313-4282
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 16
Corporate family (same tax ID) 24
Practitioners 106
-
Keith A. Boles, M.D.
-
Kelley Elizabeth Brown, LCSW
-
Rebeka Renae Calhoun, APRN, FNP-C
-
Jonathan D. Canava, LPC
-
Katie A Carranza, FNP
-
Carena Lee Chai, D.O.
-
Kimberly Madeja Cox, LCSW
-
Susan A Dornbusch, NP-C
-
James M Earhart, MD
-
Melody Fillmore, LCSW
-
Natalie Fjellanger, LCSW
-
Amy Flammer, M.D.
-
Anna Natterstad Geurkink, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D1041714 | Heart of Texas Community Health Center Inc | Accreditation | May 17, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Federally qualified health center certification: CCN 671867
- Legal name
- HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 6, 2008
- Last certification
- Mar 6, 2008
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 15, 1998 in TX
- Enrollment address
- 500 Johnson Dr
McGregor, TX 76657-1441
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Traci Mitchell |
W-2 Managing Employee | Dec 1, 2013 | |
| Roland Goertz |
Corporate Officer |
Jan 15, 1998 | |
| W-2 Managing Employee | Nov 26, 2007 | ||
| Carlton Willis |
Corporate Director |
Jul 27, 2009 | |
| Matthew Polk |
Corporate Officer |
Oct 1, 2020 | |
| Sharon Shields |
Corporate Director | Nov 26, 2007 | |
| George Johnson |
Corporate Director |
Nov 13, 2017 | |
| William Clifton |
Corporate Director | Nov 26, 2007 | |
| Martina Escalante |
Corporate Director |
Jul 7, 2009 | |
| Delia Anzaldua-Rivera |
Corporate Director |
Dec 12, 2016 | |
| David E Hunt |
Corporate Officer |
Jun 29, 2015 | |
| Annette Ballew |
Corporate Officer |
May 8, 2015 | |
| W-2 Managing Employee |
Jun 30, 1998 | ||
| Robert W Grayson |
Corporate Director | Nov 26, 2007 | |
| Roane Lacy |
Corporate Director |
Feb 23, 2009 | |
| Irene Brown |
Corporate Director |
Jan 17, 2011 | |
| Dale Barron |
Corporate Officer |
Jun 26, 2017 | |
| Patricia Burgess |
Corporate Director | Nov 26, 2007 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Waco Family Medicine - Madison Cooper |
Federally qualified health center | Operational/Managerial Control (100%) | Jun 1, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080125000528 | TX | Part a Provider - Federally Qualified Health Center (FQHC) | 1153370242 |
1 other NPI on this enrollment Practice locations: McGregor, TX |
National Provider Directory
- Tax ID family
- Heart of Texas Communit
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
500 Johnson Dr
MC Gregor, TX 76657-1441
Mailing address
1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-4200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 289056801 | Medicaid | TX | |
| FQ0000676 | Other | TX | MEDICAID |
Other names
- McGregor Community Clinic
Other providers in MC Gregor, TX
- Freedom Reins Counseling
- Roanne Gardner
- Gatesville Isd
- Go Urgent Care LLC
- Sarah Kathryn Hannah
- Heart of Texas Cooperative for Exceptional Children
- Cyle Drake Hickey
- Yvonne Hoffchen
- Kim Kennedy
- Kreis Medical Services LLC
All providers in MC Gregor, TX · Federally Qualified Health Center (FQHC) in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.