NPIMap

Organization Active NPI

Central Texas Community Health Centers

Doing business as CommUnityCare

  • Federally Qualified Health Center (FQHC)
  • Austin, TX
National Provider Identifier
1508582503
Registry record updated Oct 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL TEXAS COMMUNITY HEALTH CENTERS
Doing business as
CommUnityCare
Practice address
6633 E Highway 290 Ste 100
Austin, TX 78723-1157
Phone
(512) 978-9015
NPI assigned
Oct 12, 2022
Last updated
Oct 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2022

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

Authorized official

Name
Kimberly Middleton, CPCS, AAS, BS
Title
Managed Care Contract Manager
Phone
(512) 978-9427

Specialties & licenses 1

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

Addresses

Primary practice location

6633 E Highway 290 Ste 100
Austin, TX 78723-1157

Mailing address

PO Box 17366
Austin, TX 78760-7366
Phone (512) 978-9009

Other names 2

  • CommUnityCare Doing business as
  • Black Men's Health Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221125000552 TX Part A Provider - Federally Qualified Health Center (FQHC) 5395802151 Practice locations: Austin, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508582503. Details of each certification follow.

Federally qualified health center certification: CCN 451863

Legal name
CENTRAL TEXAS COMMUNITY HEALTH CENTERS
Doing business as
COMMUNITYCARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 16, 2022
Last certification
Nov 16, 2022
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Nov 25, 2003 in TX
Enrollment address
6633 E Highway 290
Ste 100
Austin, TX 78723-1157

National Provider Directory

National Provider Directory
Tax ID family
Central Texas Community14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Bradley Bryan Price Individual Corporate OfficerBoard Member Jun 28, 2022
Isaac Sanchez Individual Corporate DirectorBoard Member Sep 27, 2022
Paul Ballard Individual Corporate DirectorBoard Member Feb 27, 2024
Sedora Jefferson Individual Corporate DirectorBoard Member Jan 25, 2023
Carlos Manuel Gormaz Individual Corporate OfficerBoard Member Nov 17, 2020
Guy Swenson Individual Corporate OfficerBoard Member Jan 22, 2019
Steven Hewitt Garrett Individual Corporate OfficerBoard Member Oct 26, 2021
Debra Kaye Locklear Individual Corporate OfficerBoard Member Apr 20, 2011
Barbara Ann Brooks-Shirley Individual Corporate OfficerBoard Member Jan 20, 2010
Nicholas Yagoda Individual Corporate OfficerInterim Chief Executive Officer Sep 15, 2014
Joy Sloan Individual Corporate OfficerCfo Jun 1, 2019
W-2 Managing Employee Jun 5, 2017
Kimberly Janeral Johnson Individual Corporate OfficerBoard Member Mar 23, 2021

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
CommunitycarePflugerville, TX, CCN 671083 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2023
CommunitycareAustin, TX, CCN 671103 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 15, 2023

NPI Registry JSON

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

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1508582503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17366",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787607366",
            "telephone_number": "512-978-9009",
            "fax_number": "512-901-9713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6633 E HIGHWAY 290 STE 100",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787231157",
            "telephone_number": "512-978-9015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL TEXAS COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-12",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "MIDDLETON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "MANAGED CARE CONTRACT MANAGER",
        "authorized_official_telephone_number": "512-978-9427",
        "authorized_official_credential": "CPCS, AAS, BS"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CommUnityCare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Black Men's Health Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.