NPIMap

Organization Active NPI

South Padre Island Pediatric Center PA

  • Rural Health Clinic/Center
  • Taft, TX
National Provider Identifier
1538035035
Registry record updated Jan 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTH PADRE ISLAND PEDIATRIC CENTER PA
Practice address
1210 Gregory St Ste 2
Taft, TX 78390-3045
Phone
(361) 528-2595
NPI assigned
Oct 13, 2025
Last updated
Jan 20, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2026

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

Authorized official

Name
Theresa Powell
Title
Practice Administrator
Phone
(361) 854-4626

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1210 Gregory St Ste 2
Taft, TX 78390-3045

Mailing address

3845 S Padre Island Dr
Corpus Christi, TX 78415-2919
Phone (361) 854-4626

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251108000494 TX Part A Provider - Rural Health Clinic 7113009176 Practice locations: Taft, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1538035035. Details of each certification follow.

Rural health clinic certification: CCN 673858

Legal name
SOUTH PADRE ISLAND PEDIATRIC CLINIC PA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 1, 2003
Last certification
Nov 1, 2016
Ownership / control type
1A
Most recent change of ownership
Oct 1, 2025 (1 total)
Organization structure
LLCProprietary
Enrollment address
1210 Gregory St
Ste 2
Taft, TX 78390-3045

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Rural Health Solutions PA7 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 3

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

NameRoleSinceShare
Mulukutla Ramakrishna Individual 5% Or Greater Direct Ownership InterestOwner Jul 1, 1984 50%
Jorge S Rodriguez Individual 5% Or Greater Direct Ownership InterestOwner Jul 1, 1984 50%
Theresa Powell Individual W-2 Managing EmployeeAd; Oct 1, 2025 100%

Owners & managing parties with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1760313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768867200000",
    "number": "1538035035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3845 S PADRE ISLAND DR",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784152919",
            "telephone_number": "361-854-4626",
            "fax_number": "361-851-5193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 GREGORY ST STE 2",
            "city": "TAFT",
            "state": "TX",
            "postal_code": "783903045",
            "telephone_number": "361-528-2595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PADRE ISLAND PEDIATRIC CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-13",
        "last_updated": "2026-01-20",
        "certification_date": "2026-01-20",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "361-854-4626"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Taft, TX

Sources for this page

Verify at the official NPI Registry.