NPIMap

Organization Active NPI

Core Health Systems

  • Federally Qualified Health Center (FQHC)
  • Clarksville, TX
National Provider Identifier
1407553886
Registry record updated Feb 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CORE HEALTH SYSTEMS
Practice address
106 N Martin Luther King Dr
Clarksville, TX 75426-2991
Phone
(903) 427-2226
Fax
(903) 427-3227
NPI assigned
Feb 15, 2023
Last updated
Feb 26, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2025

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

Authorized official

Name
Rosemary O Villarreal, PESC
Title
Credentialing Specialist
Phone
(903) 234-4226

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

106 N Martin Luther King Dr
Clarksville, TX 75426-2991

Mailing address

107 Woodbine PL
Longview, TX 75601-2912
Phone (903) 758-2471

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230719003780 TX Part B Supplier - Clinic/Group Practice 9234599424 Receives reassigned benefits from 9 practitioners
Practice locations: Longview, TX; Texarkana, TX; Clarksville, TX
O20250417002306 TX Part A Provider - Federally Qualified Health Center (FQHC) 9234599424 Practice locations: Clarksville, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407553886. Details of each certification follow.

Federally qualified health center certification: CCN 971060

Legal name
CORE HEALTH SYSTEMS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 14, 2025
Last certification
Mar 14, 2025
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
106 N Martin Luther King Dr
Clarksville, TX 75426-2991

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory

Locations

106 N Martin Luther King Dr
#B
Clarksville, TX 75426
Phone (903) 427-2226

106 N Mlk Dr
Clarksville, TX 75426
Phone (903) 424-2226

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Marty Jordan Individual OtherBoard Member Mar 24, 2023
Linda Hooks Individual OtherBoard Member Sep 1, 2023
Sharon Leffall Individual OtherBoard Vice Chair Mar 24, 2023
Rosemary O Villarreal Individual W-2 Managing EmployeeCredentialing Specialist Feb 1, 2025
Willie P Leffall Individual OtherBoard Member Sep 1, 2023
Arturo Morales Individual OtherBoard Secretary/Treasurer Mar 24, 2023
Dawn Parker Individual OtherBoard Member Jun 16, 2023
Richard Lively Individual OtherBoard Member Sep 1, 2023
Jesse Mitchell Individual OtherBoard Member Sep 1, 2024
Hope Sellers Individual OtherBoard Member Mar 24, 2023
Jill Smith Individual OtherBoard Member Sep 1, 2023
Shirley a Baker Individual OtherBoard Member Sep 1, 2023
Leldon Williamson Individual OtherBoard Member Sep 1, 2024
Sidney Burns Individual OtherBoard Member Sep 1, 2024
Johnwayne Valdez Individual OtherEx-Officio Board Member Oct 24, 2024
Kelly Crane Individual OtherBoard Member Sep 1, 2024
Steven Wayne Archer Individual W-2 Managing EmployeeProject Director Feb 1, 2025
Larry Webb Individual OtherEx-Officio Board Member Sep 1, 2024
Henryett Porter Individual OtherBoard Chair Mar 24, 2023
Margie Smith-Whitten Individual OtherBoard Member Sep 1, 2023
Jami Duran Individual OtherBoard Member Sep 1, 2023
Wendy Bergeron Individual OtherBoard Member Oct 20, 2023

Practitioners & affiliated clinicians

Practitioners 11

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": "1676419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740528000000",
    "number": "1407553886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 WOODBINE PL",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756012912",
            "telephone_number": "903-758-2471",
            "fax_number": "903-234-1639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 N MARTIN LUTHER KING DR",
            "city": "CLARKSVILLE",
            "state": "TX",
            "postal_code": "754262991",
            "telephone_number": "903-427-2226",
            "fax_number": "903-427-3227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORE HEALTH SYSTEMS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-15",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A",
        "authorized_official_last_name": "VILLARREAL",
        "authorized_official_first_name": "ROSEMARY",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "903-234-4226",
        "authorized_official_credential": "PESC"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TX

Sources for this page

Verify at the official NPI Registry.