Amistad Community Health Center Incorporated
Organization Active NPI Federally Qualified Health Center (FQHC) · Corpus Christi, TX
NPI 1386770147 · NPPES record last updated Apr 3, 2025
Key facts
- NPI
- 1386770147
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- AMISTAD COMMUNITY HEALTH CENTER INCORPORATED
- Practice address
- 1533 S. Brownlee Blvd.
Ste. 100
Corpus Christi, TX 78404-3131 - Phone
- (361) 884-2242
- Fax
- (361) 884-2243
- NPI assigned
- Feb 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Clara Talia Peterson
- Title
- Cfo
- Phone
- (361) 886-3066
Owners & managing parties with NPI records 2
Owned or controlled facilities with NPI records 2
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 7
Practitioners 36
-
Elizabeth Granados Chavarria, APRN, FNP-C
-
Telisha Bernal, FNP
-
Chelsea Rhiannon Bueno, FNP-C
-
William Mattew Dennis, M.D.
-
Luis Fuentes III, D.O.
-
Nelly Ivonne Garcia Blow, D.O.
-
Lisette Anahi Garcia, LPC
-
David Aaron Guerra, APRN, FNP-BC
-
Riley Diane Huerta, LPC
-
Scott P Krall, MD
-
Elizabeth Ann Loika, ARNP
-
Danea Mickey, LPC
-
Karim N Nooruddin, M.D.
-
Kimberly Renee Price, FNP
-
Leticia M Reyes, LPC
-
Judith E Rubano, MD
-
Jefryn Porter Sellers, FNP-C
-
Lisa Marie Vela, MD
-
Janalee Webb, CNP
-
Molly West, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Federally qualified health center certification: CCN 671894
- Legal name
- AMISTAD COMMUNITY HEALTH CENTER INCORPORATED
- Doing business as
- RCM360 LLC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 18, 2008
- Last certification
- Aug 18, 2008
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 16, 2005 in TX
- Enrollment address
- 1533 S Brownlee Blvd
# 100
Corpus Christi, TX 78404-3131
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Belinda Flores |
Corporate Director |
Jan 1, 2012 | |
| Steven Leon Gates |
Corporate Director |
Jan 1, 2019 | |
| William Larsen |
Corporate Director |
Dec 1, 2014 | |
| Melissa L. Ramsden |
Corporate Director |
Feb 1, 2015 | |
| Patricia Truxaw |
Contracted Managing Employee |
Aug 1, 2024 | |
| W-2 Managing Employee |
Aug 1, 2024 | ||
| Carole Devos |
Contracted Managing Employee |
Dec 1, 2008 | |
| Eric Baggerman |
Corporate Officer |
Aug 1, 2024 | |
| W-2 Managing Employee |
Aug 1, 2024 | ||
| Nicholas L Adame |
Corporate Director |
Aug 1, 2018 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Rcm360 LLC |
Federally qualified health center | Operational/Managerial Control | Jan 1, 2020 |
| Amistad Community Health Center Incorporated |
Federally qualified health center | Operational/Managerial Control | Nov 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080716000705 | TX | Part a Provider - Federally Qualified Health Center (FQHC) | 8527131036 | Practice locations: Corpus Christi, TX |
| O20100405000142 | TX | Part B Supplier - Clinic/Group Practice | 8527131036 |
Receives reassigned benefits from 36 practitioners Practice locations: Aransas Pass, TX; Corpus Christi, TX; Robstown, TX |
National Provider Directory
- Tax ID family
- Amistad Comm HLTH Ctr Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1533 S. Brownlee Blvd.
Ste. 100
Corpus Christi, TX 78404-3131
Mailing address
1533 S Brownlee Blvd
Corpus Christi, TX 78404-3131
Phone (361) 844-2242
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 215071601 | Other | TX | MEDICAID TPI MULTISPECIALTY - GROUP |
| 191099401 | Medicaid | TX |
Other names
- Amistad Health
Other providers in Corpus Christi, TX
- Abdolrhim Mohamad Aminzadeh
- Amistad Children Services Inc
- Amistad Childrens Services
- Amistad Community Health Center Incorporated
- Amistad Community Health Center Incorporated
- Amistad Community Health Center Incorporated
- Amor Home Health, Inc.
- Amor Home Health, LLC
- Amor Home Health, LLC
- Ample Enterprises LLC
All providers in Corpus Christi, 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 Apr 3, 2025. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.