NPIMap

Organization Active NPI

Amistad Community Health Center Incorporated

Doing business as Amistad Health

  • Federally Qualified Health Center (FQHC)
  • Corpus Christi, TX
National Provider Identifier
1386770147
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
AMISTAD COMMUNITY HEALTH CENTER INCORPORATED
Doing business as
Amistad Health
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
Last updated
Apr 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Authorized official

Name
Clara Talia Peterson
Title
Cfo
Phone
(361) 886-3066

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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 names 1

  • Amistad Health Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386770147. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jun 16, 2005 in TX
Enrollment address
1533 S Brownlee Blvd
# 100
Corpus Christi, TX 78404-3131

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Amistad Comm HLTH Ctr Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

3602 McArdle Rd
Rm WRM2
Corpus Christi, TX 78415
Phone (361) 299-7056

814 E Main Ave
Ste 100
Robstown, TX 78380
Phone (361) 886-3040

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Belinda Flores Individual Corporate DirectorBoard Member- President Jan 1, 2012
Steven Leon Gates Individual Corporate DirectorBoard Member Jan 1, 2019
William Larsen Individual Corporate DirectorBoard Member Vice President Dec 1, 2014
Melissa L. Ramsden Individual Corporate DirectorBoard Member Feb 1, 2015
Patricia Truxaw Individual Contracted Managing EmployeeRevenue and Compliance Coordinator Aug 1, 2024
W-2 Managing EmployeeRevenue and Compliance Coordinator Aug 1, 2024
Carole Devos Individual Contracted Managing EmployeeContracting Manager Dec 1, 2008
Eric Baggerman Individual Corporate OfficerCeo Aug 1, 2024
W-2 Managing EmployeeChief Executive Officer Aug 1, 2024
Nicholas L Adame Individual Corporate DirectorBoard Member Aug 1, 2018

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 2

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

FacilityTypeRoleSince
Rcm360 LLCRobstown, TX, CCN 451103 Federally qualified health center Operational/Managerial Control Jan 1, 2020
Amistad Community Health Center IncorporatedAransas Pass, TX, CCN 451164 Federally qualified health center Operational/Managerial Control Nov 1, 2021

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743638400000",
    "number": "1386770147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1533 S BROWNLEE BLVD",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784043131",
            "telephone_number": "361-844-2242",
            "fax_number": "361-844-2243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1533 S. BROWNLEE BLVD.",
            "address_2": "STE. 100",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784043131",
            "telephone_number": "361-884-2242",
            "fax_number": "361-884-2243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMISTAD COMMUNITY HEALTH CENTER INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "CLARA",
        "authorized_official_middle_name": "TALIA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "361-886-3066"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Amistad Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Corpus Christi, TX

Sources for this page

Verify at the official NPI Registry.