NPIMap

Organization Active NPI

Community Health Service Agency, Inc.

Doing business as Carevide

  • Federally Qualified Health Center (FQHC)
  • Greenville, TX
National Provider Identifier
1528041191
Registry record updated Mar 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH SERVICE AGENCY, INC.
Doing business as
Carevide
Practice address
4311 Wesley St
Greenville, TX 75401-5639
Phone
(903) 455-5958
Fax
(903) 454-4514
NPI assigned
Nov 28, 2005
Last updated
Mar 4, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2026

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

Authorized official

Name
Michelle P Carter
Title
Cfo
Phone
(903) 455-5986

Specialties & licenses 1

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

Addresses

Primary practice location

4311 Wesley St
Greenville, TX 75401-5639

Mailing address

PO Box 1908
Greenville, TX 75403-1908
Phone (903) 455-5986

Other identifiers 1

IdentifierTypeStateIssuer
112276402MedicaidTX

Other names 1

  • Carevide Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101117001034 TX Part A Provider - Federally Qualified Health Center (FQHC) 6305735150 Practice locations: Greenville, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1528041191. Details of each certification follow.

Federally qualified health center certification: CCN 451822

Legal name
COMMUNITY HEALTH SERVICE AGENCY, INC.
Doing business as
CAREVIDE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 15, 1976 in TX
Enrollment address
4311 Wesley St
Greenville, TX 75401-5639

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Ladonia Medical Clinic7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

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
Michelle Carter Individual Corporate OfficerCeo Dec 18, 2007
Thomas J Goss Individual Corporate DirectorBoard Vice Chair Mar 31, 2015
Bryan Keith Winters Individual Corporate Director Sep 1, 2010
Stan McKee Individual Corporate DirectorBoard Chair Sep 1, 2010
Paul Kelley Individual Corporate DirectorBoard Member Apr 24, 2018
Wendi Alvarado Individual W-2 Managing Employee May 18, 2009
Alma Paulin Individual Corporate DirectorBoard Member Jun 26, 2018
Nona Jordan Individual Corporate Director Sep 1, 2010
Paul Painter Individual Corporate Director Sep 1, 2010
Amy Wade Individual Corporate DirectorBoard Secretary Apr 25, 2017
James Andrew Bench Individual Corporate Director Oct 4, 2013
Brenda Sue Cregg Individual Corporate Director Jan 1, 2012

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 12

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": "1133136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772582400000",
    "number": "1528041191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1908",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754031908",
            "telephone_number": "903-455-5986",
            "fax_number": "903-454-4621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4311 WESLEY ST",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754015639",
            "telephone_number": "903-455-5958",
            "fax_number": "903-454-4514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH SERVICE AGENCY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-28",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "903-455-5986"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112276402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carevide",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Carevide",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, TX

Sources for this page

Verify at the official NPI Registry.