NPIMap

Organization Active NPI

Tomagwa Ministries, Inc

  • Federally Qualified Health Center (FQHC)
  • Tomball, TX
National Provider Identifier
1417543422
Registry record updated May 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TOMAGWA MINISTRIES, INC
Practice address
455 School St Ste 30
Tomball, TX 77375-4595
Phone
(281) 357-0747
Fax
(832) 559-5190
NPI assigned
Dec 14, 2020
Last updated
May 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2024

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

Authorized official

Name
Timika Simmons
Title
Ceo
Phone
(832) 559-5223

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

455 School St Ste 30
Tomball, TX 77375-4595

Mailing address

455 School St Ste 30
Tomball, TX 77375-4595
Phone (281) 357-0747

Other practice location 1

1613 Key Street
Waller, TX 77484-7748
Phone (281) 357-0747

Other practice location 2

18230 Fm 1488 Rd Ste 203
Magnolia, TX 77354-4530
Phone (832) 559-5260

Other names 1

  • TOMAGWA HEALTHCARE MINISTRIES Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210422001568 TX Part B Supplier - Clinic/Group Practice 2365850872 Receives reassigned benefits from 4 practitioners
Practice locations: Magnolia, TX; Tomball, TX
O20240425003783 TX Part A Provider - Federally Qualified Health Center (FQHC) 2365850872 Practice locations: Tomball, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417543422. Details of each certification follow.

Federally qualified health center certification: CCN 741167

Legal name
TOMAGWA MINISTRIES INC
Doing business as
TOMAGWA AT TOMBALL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 4, 2024
Last certification
Apr 4, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 14, 2020 in TX
Enrollment address
455 School St
Ste 30
Tomball, TX 77375-4595

Other NPIs with the same Medicare PAC ID 1

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
45D2154575Tomagwa Ministries Inc455 School Street Suite 30, Tomball, TX 77375Provider-performed microscopySep 13, 2026

National Provider Directory

National Provider Directory
Tax ID family
Tomagwa Ministries Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Kevin Rudolph Individual Corporate DirectorBoard President Jan 1, 2020
William Berger Individual Corporate DirectorSecretary Feb 4, 2020
Timika Simmons Individual Corporate OfficerCeo Jan 1, 2019
Corporate DirectorCeo Jan 1, 2019
W-2 Managing EmployeeCeo Jan 1, 2019
Linda Whidden Flower Individual Corporate DirectorMedical Director Jan 1, 2010

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 8

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": "1607904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716508800000",
    "number": "1417543422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 SCHOOL ST STE 30",
            "city": "TOMBALL",
            "state": "TX",
            "postal_code": "773754595",
            "telephone_number": "281-357-0747",
            "fax_number": "832-559-5190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 SCHOOL ST STE 30",
            "city": "TOMBALL",
            "state": "TX",
            "postal_code": "773754595",
            "telephone_number": "281-357-0747",
            "fax_number": "832-559-5190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1613 Key Street",
            "address_purpose": "LOCATION",
            "city": "Waller",
            "state": "TX",
            "postal_code": "774847748",
            "country_code": "US",
            "telephone_number": "281-357-0747",
            "fax_number": "832-559-5190",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18230 Fm 1488 Rd Ste 203",
            "address_purpose": "LOCATION",
            "city": "Magnolia",
            "state": "TX",
            "postal_code": "773544530",
            "country_code": "US",
            "telephone_number": "832-559-5260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TOMAGWA MINISTRIES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-14",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "TIMIKA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "832-559-5223"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_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": "TOMAGWA HEALTHCARE MINISTRIES",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "TOMAGWA HEALTHCARE MINISTRIES",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tomball, TX

Sources for this page

Verify at the official NPI Registry.