NPIMap

Organization Active NPI

Stephen F Austin Community Health Center, Inc

Doing business as Pearland Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Pearland, TX
National Provider Identifier
1629577416
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC
Doing business as
Pearland Family Health Center
Practice address
2552 Broadway St Ste 102
Pearland, TX 77581-4904
Phone
(281) 824-1480
NPI assigned
Feb 7, 2018
Last updated
Mar 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Authorized official

Name
Brandy Smith
Title
Credentialing Coordinator
Phone
(281) 824-1480

Specialties & licenses 2

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

Addresses

Primary practice location

2552 Broadway St Ste 102
Pearland, TX 77581-4904

Mailing address

1111 W Adoue St
Alvin, TX 77511-2718
Phone (281) 824-1480

Other names 1

  • Pearland Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190124003709 TX Part A Provider - Federally Qualified Health Center (FQHC) 6204977127 Practice locations: Pearland, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629577416. Details of each certification follow.

Federally qualified health center certification: CCN 451039

Legal name
STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC.
Doing business as
PEARLAND FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 24, 2019
Last certification
Jan 24, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 12, 2008 in TX
Enrollment address
2552 Broadway St
Ste 102
Pearland, TX 77581-4904

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2151248Pearland Family Health Ctr2552 Broadway St Ste 102, Pearland, TX 77581Certificate of waiverJul 15, 2028

National Provider Directory

National Provider Directory
Tax ID family
CHN Pharmacy28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Marbella Hooper Individual Corporate DirectorBoard Member Secretary Aug 1, 2017 100%
Brandy Smith Individual W-2 Managing Employee Apr 7, 2016
Mark Young Individual 5% Or Greater Direct Ownership InterestCeo Apr 1, 2010 100%
Corporate OfficerCeo Apr 1, 2010 100%
Corporate DirectorCeo Apr 1, 2010 100%
Debra Fontenot Individual Corporate DirectorBoard Member Aug 21, 2018 100%
Ronald Medina Individual Corporate DirectorBoard Member Oct 20, 2015 100%
Stephen F Austin Community Health Center, Inc. Organization, Pearland, TX Non-profit 5% Or Greater Direct Ownership Interest Jul 9, 2018 100%
Bonnie Horton Individual Corporate DirectorBoard Member Apr 8, 2008 100%
Gerald Roznovsky Individual Corporate DirectorBoard Member, Chairman Apr 8, 2008 100%
Gina Adams Individual Corporate DirectorBoard Member Vice Chair Jan 1, 2015 100%

Owners & managing parties with NPI records 14

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

View all 14

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Stephen F Austin Community Health Center, Inc.Alvin, TX, CCN 671934 Federally qualified health center Operational/Managerial Control Nov 24, 2009
Mychn CallawayAlvin, TX, CCN 741976 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2017
Women and Children's Health CenterAlvin, TX, CCN 451000 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 3, 2016
Mychn WebsterWebster, TX, CCN 971091 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 16, 2017

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1517961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1629577416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 W ADOUE ST",
            "city": "ALVIN",
            "state": "TX",
            "postal_code": "775112718",
            "telephone_number": "281-824-1480",
            "fax_number": "281-220-6407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2552 BROADWAY ST STE 102",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775814904",
            "telephone_number": "281-824-1480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-07",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "281-824-1480"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pearland Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pearland, TX

Sources for this page

Verify at the official NPI Registry.