NPIMap

Organization Active NPI

Heart of Texas Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Waco, TX
National Provider Identifier
1699096503
Registry record updated Jul 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC
Practice address
1800 Gurley LN
Waco, TX 76706-4025
Phone
(254) 313-6000
Fax
(254) 313-6099
NPI assigned
Jun 15, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2017

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

Authorized official

Name
Annette Ballew, CPA
Title
Cfo
Phone
(254) 313-4282

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1800 Gurley LN
Waco, TX 76706-4025

Mailing address

1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-4200

Other identifiers 2

IdentifierTypeStateIssuer
FQ0000676OtherTXMEDICAID
285245101MedicaidTX

Other names 1

  • South 18th Street Community Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080205000574 TX Part A Provider - Federally Qualified Health Center (FQHC) 1153370242 1 other NPI on this enrollment
Practice locations: Waco, TX

Federally qualified health center certification: CCN 671871

Legal name
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
Doing business as
WACO FAMILY MEDICINE - TOM OLIVER S. 18TH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 14, 2008
Last certification
Mar 14, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 15, 1988 in TX
Enrollment address
1800 Gurley LN
Waco, TX 76706-4025

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Heart of Texas Communit25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Roland Goertz Individual Corporate OfficerCeo Jan 15, 1998
W-2 Managing Employee Nov 26, 2007
Carlton Willis Individual Corporate DirectorDirector Jul 27, 2009
Matthew Polk Individual Corporate Officer Oct 1, 2020
Sharon Shields Individual Corporate Director Nov 26, 2007
George Johnson Individual Corporate DirectorDirector Nov 13, 2017
William Clifton Individual Corporate Director Nov 26, 2007
Martina Escalante Individual Corporate DirectorDirector Jul 7, 2009
Delia Anzaldua-Rivera Individual Corporate DirectorDirector Dec 12, 2016
David E Hunt Individual Corporate OfficerChief Operating Officer Jun 29, 2015
Annette Ballew Individual Corporate OfficerCfo May 8, 2015
W-2 Managing Employee Jun 30, 1998
Robert W Grayson Individual Corporate Director Nov 26, 2007
Roane Lacy Individual Corporate DirectorDirector Feb 23, 2009
Irene Brown Individual Corporate DirectorDirector Jan 17, 2011
Dale Barron Individual Corporate OfficerChief Advancement Officer Jun 26, 2017
Patricia Burgess Individual Corporate Director Nov 26, 2007

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Waco Family Medicine - Madison CooperWaco, TX, CCN 671013 Federally qualified health center Operational/Managerial Control (100%) Jun 1, 2012

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 106

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 106

NPI Registry JSON

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

{
    "created_epoch": "1276560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501200000000",
    "number": "1699096503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 PROVIDENCE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767072261",
            "telephone_number": "254-313-4200",
            "fax_number": "254-313-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 GURLEY LN",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767064025",
            "telephone_number": "254-313-6000",
            "fax_number": "254-313-6099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART OF TEXAS COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-15",
        "last_updated": "2017-07-28",
        "status": "A",
        "authorized_official_last_name": "BALLEW",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "254-313-4282",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "FQ0000676",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "285245101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South 18th Street Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.