NPIMap

Organization Active NPI

Heart of Texas Community Health Center, Inc.

Doing business as Martin Luther King Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Waco, TX
National Provider Identifier
1477837730
Registry record updated Jul 28, 2017
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.
Doing business as
Martin Luther King Community Clinic
Practice address
1911 N Martin Luther King Jr Blvd
Waco, TX 76704-1438
Phone
(254) 313-5000
Fax
(254) 313-5099
NPI assigned
Oct 5, 2011
Last updated
Jul 28, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
HEART OF TEXAS COMMUNITY HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 28, 2017

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

Authorized official

Name
Annette Ballew, CPA
Title
Chief Financial Officer
Phone
(254) 313-4282

Specialties & licenses 2

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

Addresses

Primary practice location

1911 N Martin Luther King Jr Blvd
Waco, TX 76704-1438

Mailing address

1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-4200

Other identifiers 3

IdentifierTypeStateIssuer
068160OtherTXUNIFORM DATA SET
342969801MedicaidTX
FQ0000676MedicaidTX

Other names 1

  • Martin Luther King Community Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141205000377 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 1477837730. Details of each certification follow.

Federally qualified health center certification: CCN 741873

Legal name
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
Doing business as
WACO FAMILY MEDICINE - MARTIN LUTHER KING, JR.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 5, 2014
Last certification
Dec 5, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 15, 1998 in TX
Enrollment address
1911 N Martin Luther King Jr Blvd
Waco, TX 76704-1438

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
Part of
Heart of TX Comm HLTH Ctr

Other organizations with this tax ID 24

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

View all 24

Ownership & related parties

All disclosed owners & managing parties 18

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 Director Jun 1, 2019
Donald M Hardin Individual Corporate OfficerChief Clinical Officer May 10, 2021
Mildred Watley Individual Corporate Director Jul 19, 2021
Malcolm Duncan Individual Corporate Director Mar 23, 2020
Sherry Williams Individual Corporate Director Apr 22, 2019
Matthew Polk Individual Corporate OfficerChief Operating Officer Oct 1, 2020
Gloria Guerra Individual Corporate Director Jun 1, 2019
George Johnson Individual Corporate Director Nov 13, 2017
Tashita Bibles Individual Corporate Director Jul 19, 2021
William Clifton Individual Corporate Director Nov 13, 2017
Delia Anzaldua-Rivera Individual Corporate Director Dec 12, 2016
Annette Ballew Individual Corporate OfficerCfo May 8, 2015
W-2 Managing Employee Jun 30, 1998
Marc Barrett Individual Corporate Director Mar 23, 2020
Crisala Houston Individual Corporate OfficerCompliance & Equity Officer Feb 1, 2021
Hector Sabido Individual Corporate Director Aug 30, 2021
Dale Barron Individual Corporate Officer Jun 29, 2015
Mark Hobbs Individual Corporate Director Apr 22, 2019
Jackson O Griggs Individual Corporate OfficerChief Executive Officer Feb 25, 2019

Owners & managing parties with NPI records 2

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": "1317772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501200000000",
    "number": "1477837730",
    "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": "254-313-4200",
            "fax_number": "254-313-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 N MARTIN LUTHER KING JR BLVD",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767041438",
            "telephone_number": "254-313-5000",
            "fax_number": "254-313-5099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEART OF TEXAS COMMUNITY HEALTH CENTER, INC",
        "enumeration_date": "2011-10-05",
        "last_updated": "2017-07-28",
        "status": "A",
        "authorized_official_last_name": "BALLEW",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "254-313-4282",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIFORM DATA SET",
            "identifier": "068160",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "342969801",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQ0000676",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Martin Luther King Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.