NPIMap

Organization Active NPI

Heart of Texas Community Health Center, Inc.

Doing business as Waco Family Medicine - Santa Fe

  • Federally Qualified Health Center (FQHC)
  • Temple, TX
National Provider Identifier
1306234521
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
Doing business as
Waco Family Medicine - Santa Fe
Practice address
600 S 25TH St Ste 115
Temple, TX 76504-5227
Phone
(254) 899-8650
Fax
(254) 899-8669
NPI assigned
Dec 23, 2014
Last updated
Apr 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

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

Authorized official

Name
Matthew Polk
Title
Chief Operating Officer
Phone
(254) 313-4412

Specialties & licenses 2

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

Addresses

Primary practice location

600 S 25TH St Ste 115
Temple, TX 76504-5227

Mailing address

1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-4200

Other identifiers 1

IdentifierTypeStateIssuer
344169301MedicaidTX

Other names 1

  • Waco Family Medicine - Santa Fe Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150224001396 TX Part A Provider - Federally Qualified Health Center (FQHC) 1153370242 Practice locations: Temple, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306234521. Details of each certification follow.

Federally qualified health center certification: CCN 741879

Legal name
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
Doing business as
WACO FAMILY MEDICINE - SANTA FE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 24, 2015
Last certification
Feb 24, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 15, 1998 in TX
Enrollment address
600 S 25TH St
Ste 115
Temple, TX 76504-5227

Other NPIs with the same Medicare PAC ID 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Heart of TX Comm HLTH Ctr25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

Locations

600 S 25th St
Ste 115
Temple, TX 76504
Phone (254) 899-8650

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Kristen Padilla-Manor Individual Corporate Director Jun 1, 2019
Donald M Hardin Individual Corporate OfficerChief Clinical Officer May 10, 2021
Mildred Watley Individual Corporate Director Jul 19, 2021
Malcolm Duncan Individual Corporate Director Mar 23, 2020
Sherry Williams Individual Corporate Director Apr 22, 2019
Matthew Polk Individual Corporate OfficerChief Operating Officer Oct 1, 2020
Gloria Guerra Individual Corporate Director Jun 1, 2019
George Johnson Individual Corporate Director Nov 13, 2017
Tashita Bibles Individual Corporate Director Jul 19, 2021
William Clifton Individual Corporate Director Oct 26, 2015
Delia Anzaldua-Rivera Individual Corporate Director Dec 12, 2016
Annette Ballew Individual Corporate OfficerCfo May 8, 2015
W-2 Managing Employee Jun 30, 1998
Marc Barrett Individual Corporate Director Mar 23, 2020
Crisala Houston Individual Corporate OfficerCompliance & Equity Officer Feb 1, 2021
Hector Sabido Individual Corporate Director Aug 30, 2021
Dale Barron Individual Corporate OfficerChief Advancement Officer Jun 29, 2015
Mark Hobbs Individual Corporate Director Apr 22, 2019
Jackson O Griggs Individual Corporate OfficerChief Executive Officer Feb 25, 2019

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Waco Family Medicine - Madison CooperWaco, TX, CCN 671013 Federally qualified health center Operational/Managerial Control (100%) Jun 1, 2012

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1419292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744156800000",
    "number": "1306234521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 PROVIDENCE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767072261",
            "telephone_number": "254-313-4200",
            "fax_number": "254-313-4531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S 25TH ST STE 115",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765045227",
            "telephone_number": "254-899-8650",
            "fax_number": "254-899-8669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-23",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A",
        "authorized_official_last_name": "POLK",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "254-313-4412"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344169301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waco Family Medicine - Santa Fe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Temple, TX

Sources for this page

Verify at the official NPI Registry.