Christus Health Southeast Texas
Organization Active NPI Rural Health Clinic/Center · Jasper, TX
NPI 1528030285 · NPPES record last updated Oct 19, 2022
Key facts
- NPI
- 1528030285
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- CHRISTUS HEALTH SOUTHEAST TEXAS
- Practice address
- 1276 S Peachtree St
Jasper, TX 75951-4916 - Phone
- (409) 384-5701
- Fax
- (409) 384-4238
- NPI assigned
- Feb 6, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- CHRISTUS HEALTH
Authorized official
- Name
- Paul Trevino
- Title
- President / Ceo
- Phone
- (409) 899-7102
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 4
Related certifications (CCN) 1
Facilities with the same owner 47
Practitioners 5
-
Kamesha Jennel Barnes, CPN, FNP-C
-
Amanda Minick Reneau, APN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D0679085 | Christus Southeast Texas Family Practice Ctr | Accreditation | Jun 24, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Rural health clinic certification: CCN 453480
- Legal name
- CHRISTUS HEALTH SOUTHEAST TEXAS
- Doing business as
- CHRISTUS SOUTHEAST TEXAS FAMILY PRACTICE CENTER -JASPER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Dec 6, 1993
- Last certification
- Oct 24, 2018
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 4, 1999 in TX
- Enrollment address
- 1276 S Peachtree St
Jasper, TX 75951-4916 - Related CCNs
- 450573
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Paul Trevino |
Corporate Officer |
Jan 16, 2014 | |
| W-2 Managing Employee |
Jan 16, 2014 | ||
| Christus Health |
5% Or Greater Direct Ownership Interest | Feb 1, 1999 | 100% |
| Kim-Phuong Tran |
Corporate Director |
Jan 1, 2023 | |
| Kimberly King Webb |
Corporate Director |
Feb 7, 2024 | |
| Roy Steinhagen |
Corporate Director |
Jan 1, 2026 | |
| Rebecca M Schneider |
W-2 Managing Employee |
Dec 28, 2021 | |
| Shawn Michael Adams |
Corporate Officer |
Mar 1, 2014 | |
| W-2 Managing Employee |
Mar 1, 2014 | ||
| Sonia Acosta |
Corporate Director |
Sep 16, 2024 | |
| Fadi V Nasrallah |
Corporate Director |
Feb 7, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040707000488 | TX | Part a Provider - Rural Health Clinic | 3476460049 | Practice locations: Jasper, TX |
National Provider Directory
- Tax ID family
- Christus Health SE Texas
- Part of
- Christus Spohn Family Health Center Freer
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | TX | Yes |
Addresses
Primary practice location
1276 S Peachtree St
Jasper, TX 75951-4916
Mailing address
PO Box 848060
Dallas, TX 75284-8060
Phone (800) 756-7999
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 137305204 | Medicaid | TX |
Other names
- CHRISTUS SOUTHEAST TEXAS FAMILY PRACTICE CENTER - JASPER
- CHRISTUS Southeast Texas - Family Practice Center Jasper
Other providers in Jasper, TX
- Chartwell Community Service, Inc
- Chartwell Community Services, Inc.
- Kasim Chaudhry
- Children'S Clinic of Jasper
- Christus Health Southeast Texas
- Christus Health Southeast Texas
- Christus Health Southeast Texas
- Christus Health Southeast Texas
- Christus Jasper Memorial Hospital Family Practice Center - Jasper
- Clear Choice Hearing Solutions LLC
All providers in Jasper, TX · Rural Health Clinic/Center in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.