NPIMap

Organization Active NPI

Community Health Service Agency, Inc.

Doing business as Carevide

  • Federally Qualified Health Center (FQHC)
  • Cooper, TX
National Provider Identifier
1700067253
Registry record updated Mar 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH SERVICE AGENCY, INC.
Doing business as
Carevide
Practice address
91 W Side SQ
Cooper, TX 75432-1725
Phone
(903) 395-0586
Fax
(903) 395-0589
NPI assigned
Nov 26, 2007
Last updated
Mar 4, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2026

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

Authorized official

Name
Michelle P Carter
Title
Cfo
Phone
(903) 455-5986

Specialties & licenses 1

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

Addresses

Primary practice location

91 W Side SQ
Cooper, TX 75432-1725

Mailing address

PO Box 1908
Greenville, TX 75403-1908
Phone (903) 455-5986

Other identifiers 1

IdentifierTypeStateIssuer
191774201MedicaidTX

Other names 1

  • Carevide Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040612000279 TX Part B Supplier - Clinic/Group Practice 6305735150 Receives reassigned benefits from 25 practitioners
1 other NPI on this enrollment
Practice locations: Sulphur Springs, TX; Kaufman, TX; Greenville, TX; Farmersville, TX; Cooper, TX; Commerce, TX
O20080111000104 TX Part A Provider - Federally Qualified Health Center (FQHC) 6305735150 Practice locations: Cooper, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700067253. Details of each certification follow.

Federally qualified health center certification: CCN 671887

Legal name
COMMUNITY HEALTH SERVICE AGENCY, INC.
Doing business as
CAREVIDE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 30, 2008
Last certification
May 30, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 15, 1976 in TX
Enrollment address
91 W Side SQ
Cooper, TX 75432-1725

Other NPIs with the same Medicare PAC ID 6

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

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

Locations

91 W Side Sq
Cooper, TX 75432
Phone (903) 395-0586

4311 Wesley St
Greenville, TX 75401
Phone (903) 455-5958

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Michelle Carter Individual Corporate OfficerCeo Jan 1, 2013
Thomas J Goss Individual Corporate DirectorBoard Member Mar 31, 2015
Bryan Keith Winters Individual Corporate DirectorBoard Member Oct 1, 2002
Stan McKee Individual Corporate DirectorBoard Member Jan 1, 2002
Paul Kelley Individual Corporate DirectorBoard Member Apr 24, 2018
Wendi Alvarado Individual W-2 Managing EmployeeCredentialing May 1, 2014
Alma Paulin Individual Corporate DirectorBoard Member Jun 26, 2018
Nona Jordan Individual Corporate DirectorBoard Member Oct 1, 1997
Paul Painter Individual Corporate DirectorBoard Member Oct 1, 1997
Amy Wade Individual Corporate DirectorBoard Secretary Apr 25, 2017
James Andrew Bench Individual Corporate DirectorBoard Member Oct 1, 2013
Brenda Sue Cregg Individual Corporate DirectorBoard Member Jan 1, 2012

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1196035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772582400000",
    "number": "1700067253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1908",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754031908",
            "telephone_number": "903-455-5986",
            "fax_number": "903-454-4621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 W SIDE SQ",
            "city": "COOPER",
            "state": "TX",
            "postal_code": "754321725",
            "telephone_number": "903-395-0586",
            "fax_number": "903-395-0589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH SERVICE AGENCY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-26",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "903-455-5986"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "191774201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carevide",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Carevide",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cooper, TX

Sources for this page

Verify at the official NPI Registry.