NPIMap

Organization Active NPI

Health Center of Southeast Texas

Doing business as Health Center of Southeast Texas-Livingston

  • Federally Qualified Health Center (FQHC)
  • Livingston, TX
National Provider Identifier
1659744217
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEALTH CENTER OF SOUTHEAST TEXAS
Doing business as
Health Center of Southeast Texas-Livingston
Practice address
204 W Park
Livingston, TX 77351-9336
Phone
(936) 327-4660
NPI assigned
Nov 4, 2015
Last updated
Feb 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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

Authorized official

Name
Mr. Steven Racciato
Title
Executive Director
Phone
(281) 592-2224

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Nurse Practitioner 363LF0000X
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

204 W Park
Livingston, TX 77351-9336

Mailing address

307 N William Barnett Ave
Cleveland, TX 77327-4061
Phone (281) 592-2224

Other identifiers 1

IdentifierTypeStateIssuer
179566803MedicaidTX

Other names 1

  • Health Center of Southeast Texas-Livingston Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060223000543 TX Part B Supplier - Clinic/Group Practice 9739195041 Receives reassigned benefits from 22 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cleveland, TX; Shepherd, TX; Livingston, TX; Liberty, TX; Dayton, TX
O20161207000378 TX Part A Provider - Federally Qualified Health Center (FQHC) 9739195041 Practice locations: Livingston, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659744217. Details of each certification follow.

Federally qualified health center certification: CCN 741939

Legal name
HEALTH CENTER OF SOUTHEAST TEXAS
Doing business as
HEALTH CENTER OF SOUTHEAST TEXAS-LIVINGSTON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 14, 2016
Last certification
Dec 14, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 14, 2005 in TX
Enrollment address
204 W Park
Livingston, TX 77351-9336

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Health Center of Southeast6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

204 W Park
Ste 200
Livingston, TX 77352
Phone (936) 327-4660

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Susan Bailes Individual Corporate DirectorChairman of the Board Jul 18, 2016
Ilona Molton Individual Corporate DirectorVice Chairman of the Board Oct 9, 2014
Jennifer L Bergman Individual Corporate DirectorBoard Member Jan 14, 2016
Sherrell Wolfe Individual Corporate DirectorBoard Member Jul 18, 2013
Amalia Reddell Individual Corporate DirectorBoard Member Feb 13, 2008
Eisha Jones Individual Corporate DirectorBoard Secretary Feb 11, 2016
Andee Kesner Individual Corporate OfficerChief Executive Officer May 4, 2026
Corporate DirectorChief Executive Officer May 4, 2026
W-2 Managing EmployeeChief Executive Officer May 4, 2026
Amanda Brooks Individual Corporate DirectorBoard Member Jun 9, 2023
Magdalena Estrada Individual Corporate OfficerChief Executive Officer May 4, 2026
Corporate DirectorChief Executive Officer May 4, 2026
W-2 Managing EmployeeChief Executive Officer May 4, 2026
Kari Rhodes Individual Corporate Officer Oct 13, 2022
James Smith Individual Corporate DirectorSecretary Sep 12, 2019

Practitioners & affiliated clinicians

Practitioners 5

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": "1446595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1659744217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 N WILLIAM BARNETT AVE",
            "city": "CLEVELAND",
            "state": "TX",
            "postal_code": "773274061",
            "telephone_number": "281-592-2224",
            "fax_number": "281-592-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W PARK",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773519336",
            "telephone_number": "936-327-4660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH CENTER OF SOUTHEAST TEXAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-04",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A",
        "authorized_official_last_name": "RACCIATO",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "281-592-2224",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179566803",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Center of Southeast Texas-Livingston",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Health Center of Southeast Texas-Livingston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Livingston, TX

Sources for this page

Verify at the official NPI Registry.