NPIMap

Organization Active NPI

Matagorda Episcopal Health Outreach Program

Doing business as MEHOP Wharton Health 2

  • Federally Qualified Health Center (FQHC)
  • Wharton, TX
National Provider Identifier
1568075638
Registry record updated Jul 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MATAGORDA EPISCOPAL HEALTH OUTREACH PROGRAM
Doing business as
MEHOP Wharton Health 2
Vibrance Health
Practice address
2112 Regional Medical Dr Ste 1317
Wharton, TX 77488-1413
Phone
(979) 245-2008
NPI assigned
Aug 28, 2020
Last updated
Jul 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2024

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

Authorized official

Name
Celeste Harrison
Title
Ceo
Phone
(979) 245-2008

Specialties & licenses 1

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

Addresses

Primary practice location

2112 Regional Medical Dr Ste 1317
Wharton, TX 77488-1413

Mailing address

101 Avenue F N
Bay City, TX 77414-3167
Phone (979) 245-2008

Other names 2

  • MEHOP Wharton Health 2 Doing business as
  • Vibrance Health Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL www.athenanet.athenahealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050415000038 TX Part B Supplier - Clinic/Group Practice 6002853538 Receives reassigned benefits from 31 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bay City, TX; Palacios, TX; Wharton, TX
O20201113001885 TX Part A Provider - Federally Qualified Health Center (FQHC) 6002853538 Practice locations: Wharton, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568075638. Details of each certification follow.

Federally qualified health center certification: CCN 451127

Legal name
MATAGORDA EPISCOPAL HEALTH OUTREACH PROGRAM CORPORATION
Doing business as
VIBRANCE HEALTH WHARTON HEALTH 2
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 13, 2020
Last certification
Nov 13, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 2003 in TX
Enrollment address
2112 Regional Medical Center Drive
Suite 1317
Wharton, TX 77488

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Matagorda Episcopal Health Outreach Program Corporation12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Tisha Zalman Individual Corporate OfficerCfo Jul 6, 2021
W-2 Managing EmployeeCfo Jul 6, 2021
Nan Harrison Individual Corporate OfficerCeo Jul 13, 2008
W-2 Managing EmployeeChief Executive Officer Jul 13, 2008 50%

Practitioners & affiliated clinicians

Practitioners 2

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": "1598572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721260800000",
    "number": "1568075638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 AVENUE F N",
            "city": "BAY CITY",
            "state": "TX",
            "postal_code": "774143167",
            "telephone_number": "979-245-2008",
            "fax_number": "979-314-7164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 REGIONAL MEDICAL DR STE 1317",
            "city": "WHARTON",
            "state": "TX",
            "postal_code": "774881413",
            "telephone_number": "979-245-2008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATAGORDA EPISCOPAL HEALTH OUTREACH PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-28",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "CELESTE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "979-245-2008"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.athenanet.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Cloud base application",
            "address_1": "2112 Regional Medical Center, Suite 1317",
            "city": "Wharton",
            "state": "TX",
            "country_code": "US",
            "postal_code": "774889719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "MEHOP Wharton Health 2",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vibrance Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wharton, TX

Sources for this page

Verify at the official NPI Registry.