NPIMap

Organization Active NPI

North Texas Area Community Health Centers, Inc.

Doing business as Northside Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Fort Worth, TX
National Provider Identifier
1568420800
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTH TEXAS AREA COMMUNITY HEALTH CENTERS, INC.
Doing business as
Northside Community Health Center
Practice address
2332 Beverly Hills Dr
Fort Worth, TX 76114-1756
Phone
(817) 625-4254
Fax
(817) 740-8612
NPI assigned
May 3, 2006
Last updated
Oct 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Authorized official

Name
Gerrie Whitaker
Title
Ceo
Phone
(817) 625-4254

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X TX Primary
Family Medicine Physician 207Q00000X TX

Addresses

Primary practice location

2332 Beverly Hills Dr
Fort Worth, TX 76114-1756

Mailing address

2332 Beverly Hills Dr
Fort Worth, TX 76114
Phone (817) 625-4254

Other names 1

  • Northside Community Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051013000135 TX Part A Provider - Federally Qualified Health Center (FQHC) 9931124450 Practice locations: Fort Worth, TX
O20051221000461 TX Part B Supplier - Clinic/Group Practice 9931124450 Receives reassigned benefits from 19 practitioners
Practice locations: Fort Worth, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568420800. Details of each certification follow.

Federally qualified health center certification: CCN 671827

Legal name
NORTH TEXAS AREA COMMUNITY HEALTH CENTERS INC
Doing business as
NORTHSIDE COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 20, 2006
Last certification
Jan 20, 2006
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 28, 2002 in TX
Enrollment address
2332 Beverly Hills Dr
Fort Worth, TX 76114-1756

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Locations

2100 N Main St
Ste 107
Ft Worth, TX 76164
Phone (817) 625-4254

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Diann Sanchez Individual Corporate Director Jan 1, 2014
Susan Willis Individual Corporate OfficerCorporate Compliance Officer Dec 1, 2023
William R Venable Individual Corporate OfficerVice President Jan 1, 2022
Charles Smith Individual Corporate OfficerCfo Apr 1, 2024
Gregory M Eastin Individual Corporate DirectorTreasurer Jan 15, 2006
Lori Kennedy Individual Corporate OfficerPresident Jan 1, 2022
Geraldine Whitaker Individual W-2 Managing EmployeeExecutive Director Aug 1, 2017

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Southeast Community Health CenterFort Worth, TX, CCN 671949 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Feb 21, 2022
Feb 21, 2022
Arlington Community Health CenterArlington, TX, CCN 741914 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Sep 2, 2015
Sep 2, 2015

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1568420800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2332 BEVERLY HILLS DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76114",
            "telephone_number": "817-625-4254",
            "fax_number": "817-740-8612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2332 BEVERLY HILLS DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761141756",
            "telephone_number": "817-625-4254",
            "fax_number": "817-740-8612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH TEXAS AREA COMMUNITY HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A",
        "authorized_official_last_name": "WHITAKER",
        "authorized_official_first_name": "GERRIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-625-4254"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "TX",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northside Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northside Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.