NPIMap

Organization Active NPI

Heart of Texas Community Health Center Inc

Doing business as Waco Family Medicine

  • Federally Qualified Health Center (FQHC)
  • Waco, TX
National Provider Identifier
1386427334
Registry record updated Aug 15, 2023
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
Practice address
6500 Imperial Dr.
Ste 200
Waco, TX 76712
Phone
(253) 313-6600
NPI assigned
Aug 15, 2023
Last updated
Aug 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Authorized official

Name
Matthew Polk
Title
Coo
Phone
(254) 313-4412

Specialties & licenses 1

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

Addresses

Primary practice location

6500 Imperial Dr.
Ste 200
Waco, TX 76712

Mailing address

1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-4412

Other names 1

  • Waco Family Medicine Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050114000813 TX Part B Supplier - Clinic/Group Practice 1153370242 Receives reassigned benefits from 162 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bellmead, TX; Waco, TX; Temple, TX; MC Gregor, TX; Hillsboro, TX
O20231010001763 TX Part A Provider - Federally Qualified Health Center (FQHC) 1153370242 Practice locations: Waco, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386427334. Details of each certification follow.

Federally qualified health center certification: CCN 671149

Legal name
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
Doing business as
WACO FAMILY MEDICINE - IMPERIAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 17, 2023
Last certification
Oct 17, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 15, 1998 in TX
Enrollment address
6500 Imperial Dr.
Suite 200
Waco, TX 76712

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

Other NPIs on the same Medicare enrollment 2

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

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
45D2285966Heart of Texas Community Health Center Inc6500 Imperial Dr Suite 200, Waco, TX 76712AccreditationJul 22, 2026

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

6500 Imperial Dr
Ste 200
Waco, TX 76712
Phone (253) 313-6600

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 Officer Jun 1, 2019
Donald M Hardin Individual Corporate Officer May 10, 2021
Joshua Lee Caballero Individual Corporate Director Oct 24, 2022
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 Officer Oct 1, 2020
Operational/Managerial Control 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 Officer May 8, 2015
Marc Barrett Individual Corporate Director Mar 23, 2020
Dale Barron Individual Corporate Officer Jun 29, 2015
Luis Arroyo Individual Corporate Officer Feb 24, 2020
Mark Hobbs Individual Corporate Director Sep 16, 2019
Jackson O Griggs Individual Corporate 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 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1692057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692057600000",
    "number": "1386427334",
    "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": "254-313-4412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 IMPERIAL DR.",
            "address_2": "STE 200",
            "city": "WACO",
            "state": "TX",
            "postal_code": "76712",
            "telephone_number": "253-313-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART OF TEXAS COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-15",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-11",
        "status": "A",
        "authorized_official_last_name": "POLK",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "254-313-4412"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waco Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.