NPIMap

Organization Active NPI

Heart of Texas Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Waco, TX
National Provider Identifier
1417814674
Registry record updated Jan 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
Practice address
700 S 15TH St
Waco, TX 76706-1718
Phone
(254) 313-5790
NPI assigned
Jan 8, 2026
Last updated
Jan 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2026

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

Authorized official

Name
Matthew Polk
Title
Coo
Phone
(254) 313-4412

Specialties & licenses 2

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

Addresses

Primary practice location

700 S 15TH St
Waco, TX 76706-1718

Mailing address

1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-5790

Other names 1

  • Waco Family Medicine - Cesar Chavez Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260414003643 TX Part A Provider - Federally Qualified Health Center (FQHC) 1153370242 Practice locations: Waco, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417814674. Details of each certification follow.

Federally qualified health center certification: CCN 971110

Legal name
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
Doing business as
WACO FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 31, 2026
Last certification
Mar 31, 2026
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
700 S 15TH St
Waco, TX 76706-1718

Other NPIs with the same Medicare PAC ID 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Heart of TX Comm HLTH Ctr25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

Locations

700 S 15th St
Waco, TX 76706
Phone (254) 313-5790

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Kristen Padilla-Manor Individual Corporate DirectorBoard Member May 23, 2022
Donald M Hardin Individual W-2 Managing EmployeeChief Clinical Officer May 10, 2021
Joshua Lee Caballero Individual Corporate DirectorBoard Member Oct 24, 2022
Lacy McNamee Individual Corporate OfficerBoard Member Oct 1, 2023
Javier Torres Individual Corporate DirectorBoard Member Jan 27, 2025
Matthew Polk Individual Corporate OfficerChief Operating Officer Oct 1, 2023
W-2 Managing EmployeeChief Operating Officer Oct 1, 2023
Gloria Guerra Individual Corporate DirectorBoard Member Jun 1, 2019
Tashita Bibles Individual Corporate DirectorBoard Member Jul 19, 2021
James Morrison Individual Corporate DirectorBoard Member Oct 1, 2023
Alex M Jones-Adesina Individual Corporate OfficerChief Equity Officer Jul 3, 2023
Craig Hargenrader Individual Corporate OfficerCfo Jan 5, 2024
W-2 Managing EmployeeCfo Jan 5, 2024
Luis Arroyo Individual W-2 Managing EmployeeChief People Officer Feb 24, 2023
Mark Hobbs Individual Corporate OfficerBoard Member Oct 28, 2024
Jackson O Griggs Individual Corporate OfficerChief Executive Officer Feb 25, 2019
W-2 Managing EmployeeChief Executive Officer Feb 25, 2019

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Waco Family Medicine - Madison CooperWaco, TX, CCN 671013 Federally qualified health center Operational/Managerial Control (100%) Jun 1, 2012

Owned or controlled facilities with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1767830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767830400000",
    "number": "1417814674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 PROVIDENCE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767072261",
            "telephone_number": "254-313-5790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S 15TH ST",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767061718",
            "telephone_number": "254-313-5790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-08",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-08",
        "status": "A",
        "authorized_official_last_name": "POLK",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "254-313-4412"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waco Family Medicine - Cesar Chavez",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.