NPIMap

Organization Active NPI

St Hope Foundation Inc

  • Federally Qualified Health Center (FQHC)
  • Dickinson, TX
National Provider Identifier
1417424912
Registry record updated Jun 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ST HOPE FOUNDATION INC
Doing business as
St Hope Foundation, Inc
Practice address
3750 Medical Center Blvd Ste 150
Dickinson, TX 77539-7385
Phone
(832) 738-1305
Fax
(866) 316-2044
NPI assigned
Nov 1, 2018
Last updated
Jun 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2021

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

Authorized official

Name
Mika Sam-Cooper
Title
Chief Operating Officer
Phone
(713) 778-1300

Specialties & licenses 1

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

Addresses

Primary practice location

3750 Medical Center Blvd Ste 150
Dickinson, TX 77539-7385

Mailing address

6200 Savoy Dr Ste 540
Houston, TX 77036-3338
Phone (713) 778-1300

Other identifiers 1

IdentifierTypeStateIssuer
4191678-01MedicaidTX

Other names 1

  • St Hope Foundation, Inc Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040219000896 TX Part B Supplier - Clinic/Group Practice 4880508878 Receives reassigned benefits from 19 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sugar Land, TX; Conroe, TX; Jersey Village, TX; Houston, TX; Dickinson, TX; Bellaire, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417424912. Details of each certification follow.

  • CCN 451116 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 451116

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
ST HOPE FOUNDATION INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 26, 2020
Last certification
Feb 26, 2020
Ownership / control type
For profit – corporation
Facility address
3750 Medical Park Boulevard, Suite 150
Dickinson, TX 77539

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1541030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623283200000",
    "number": "1417424912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 SAVOY DR STE 540",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770363338",
            "telephone_number": "713-778-1300",
            "fax_number": "713-778-0827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 MEDICAL CENTER BLVD STE 150",
            "city": "DICKINSON",
            "state": "TX",
            "postal_code": "775397385",
            "telephone_number": "832-738-1305",
            "fax_number": "866-316-2044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST HOPE FOUNDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-01",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A",
        "authorized_official_last_name": "SAM-COOPER",
        "authorized_official_first_name": "MIKA",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "713-778-1300"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4191678-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Hope Foundation, Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St Hope Foundation, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dickinson, TX

Sources for this page

Verify at the official NPI Registry.