NPIMap

Organization Active NPI

North Texas Area Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Fort Worth, TX
National Provider Identifier
1700192085
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
516819 Issued in TX
Legal business name
NORTH TEXAS AREA COMMUNITY HEALTH CENTERS, INC
Practice address
2909 Mitchell Blvd
Fort Worth, TX 76105-4642
Phone
(817) 625-4254
Fax
(817) 740-8612
NPI assigned
Aug 25, 2010
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
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X TX
Federally Qualified Health Center (FQHC) 261QF0400X 516819 TX Primary

Addresses

Primary practice location

2909 Mitchell Blvd
Fort Worth, TX 76105-4642

Mailing address

2332 Beverly Hills Dr
Fort Worth, TX 76114-1756
Phone (817) 625-4254

Other names 1

  • Southeast Community 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
O20100903000465 TX Part A Provider - Federally Qualified Health Center (FQHC) 9931124450 Practice locations: Fort Worth, TX

Federally qualified health center certification: CCN 671949

Legal name
NORTH TEXAS AREA COMMUNITY HEALTH CENTERS INC
Doing business as
SOUTHEAST COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 27, 2010
Last certification
Sep 27, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 28, 2002 in TX
Enrollment address
2909 Mitchell Blvd
Fort Worth, TX 76105-4642

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
Tax ID family
North Texas Area Community Health Centers Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 8

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 DirectorBoard Member Oct 18, 2013
Susan Willis Individual Corporate OfficerCorporate Compliance Officer Dec 31, 2023
William R Venable Individual Corporate OfficerVice President Jan 1, 2022
Charles Smith Individual Corporate OfficerCfo Apr 1, 2024
Gregory M Eastin Individual Corporate Director Jun 29, 2009
Lori Kennedy Individual Corporate OfficerPresident Jan 1, 2022
Geraldine Whitaker Individual Corporate DirectorExecutive Director Aug 1, 2017
W-2 Managing Employee Aug 1, 2017
North Texas Area Community Health Centers Inc Organization, Fort Worth, TX Non-profit 5% Or Greater Direct Ownership Interest Feb 21, 2022 100%
Operational/Managerial Control Feb 21, 2022

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
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 1

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

Facilities with the same owner 1

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": "1282694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1700192085",
    "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": "761141756",
            "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": "2909 MITCHELL BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761054642",
            "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": "2010-08-25",
        "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": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "TX",
            "license": "516819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southeast 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.