NPIMap

Organization Active NPI

Community Health Centers of South Central Texas, Inc.

Doing business as Bastrop ISD Health Center

  • Federally Qualified Health Center (FQHC)
  • Bastrop, TX
National Provider Identifier
1407406333
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.
Doing business as
Bastrop ISD Health Center
Practice address
1602 Hill St
Bastrop, TX 78602-2525
Phone
(830) 672-6511
Fax
(830) 672-6430
NPI assigned
Sep 12, 2019
Last updated
Sep 3, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

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

Authorized official

Name
Rafael De la Paz
Title
Ceo
Phone
(830) 672-6511

Specialties & licenses 1

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

Addresses

Primary practice location

1602 Hill St
Bastrop, TX 78602-2525

Mailing address

PO Box 1890
Gonzales, TX 78629-1390
Phone (830) 672-6511

Other names 1

  • Bastrop ISD Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191007002241 TX Part A Provider - Federally Qualified Health Center (FQHC) 4688650328 Practice locations: Bastrop, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407406333. Details of each certification follow.

Federally qualified health center certification: CCN 451076

Legal name
COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 7, 2019
Last certification
Oct 7, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 1974 in TX
Enrollment address
1602 Hill St
Bastrop, TX 78602-2525

Other NPIs with the same Medicare PAC ID 7

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

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
45D2180254Bastrop Isd Health Center1602 Hill Street, Bastrop, TX 78602Certificate of waiverMar 9, 2028

National Provider Directory

National Provider Directory
Part of
Community Health Centers of

Locations

228 Saint George St
Gonzales, TX 78629
Phone (830) 672-6511

229 Saint George St
Gonzales, TX 78629
Phone (830) 672-6511

1201 W Court St
Seguin, TX 78155
Phone (830) 379-9797

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Daniel Kleiner Individual Corporate OfficerTreasurer Aug 1, 2023
Dorothy Eberle Individual Corporate DirectorSecretary Mar 1, 2006
Lisa Burns Individual Corporate Director Apr 22, 2013
Rafael Delapaz Individual Corporate Officer Jan 1, 2019
W-2 Managing Employee Oct 5, 2009
Rosie Flores Individual Corporate OfficerVice President May 1, 2006
Charlie Patterson Individual Corporate DirectorPresident Jul 1, 2014
Raziel Delabarreda Individual Corporate OfficerChief Operating Officer Jul 27, 2017
W-2 Managing EmployeeCoo Oct 1, 2001
Gary Clack Individual Corporate DirectorBoard Member Aug 13, 2024
Phillip Borowitz Individual Corporate Director Jan 1, 2010
Rhonda Hunnicutt Individual Corporate Director Nov 15, 2022

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1568246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599091200000",
    "number": "1407406333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1890",
            "city": "GONZALES",
            "state": "TX",
            "postal_code": "786291390",
            "telephone_number": "830-672-6511",
            "fax_number": "830-672-6430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 HILL ST",
            "city": "BASTROP",
            "state": "TX",
            "postal_code": "786022525",
            "telephone_number": "830-672-6511",
            "fax_number": "830-672-6430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC.",
        "enumeration_date": "2019-09-12",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A",
        "authorized_official_last_name": "DE LA PAZ",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "830-672-6511"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bastrop ISD Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bastrop ISD Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bastrop, TX

Sources for this page

Verify at the official NPI Registry.