NPIMap

Organization Active NPI

Healthtexas Provider Network

Doing business as Pca Greenville

  • Rural Health Clinic/Center
  • Greenville, TX
National Provider Identifier
1790723468
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HEALTHTEXAS PROVIDER NETWORK
Doing business as
Pca Greenville
Practice address
4400 Ih 30 W
Suite 100
Greenville, TX 75402-4620
Phone
(469) 800-3524
Fax
(469) 800-3564
NPI assigned
Jun 3, 2006
Last updated
Jun 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2022

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

Authorized official

Name
Jessica Harding
Title
Operations Manager
Phone
(469) 800-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

4400 Ih 30 W
Suite 100
Greenville, TX 75402-4620

Mailing address

8080 N Central Expy Ste 600
Dallas, TX 75206-3794
Phone (469) 800-8649

Other identifiers 4

IdentifierTypeStateIssuer
091888002MedicaidTX
00J629OtherTXBCBS GROUP
137940601MedicaidTX
137940607MedicaidTX

Other names 1

  • PCA GREENVILLE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161003002570 TX Part A Provider - Rural Health Clinic 1355254210 Practice locations: Greenville, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790723468. Details of each certification follow.

Rural health clinic certification: CCN 453870

Legal name
HEALTHTEXAS PROVIDER NETWORK
Doing business as
PCA GREENVILLE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 14, 1993
Last certification
Nov 10, 2015
Ownership / control type
1B
Most recent change of ownership
Jun 1, 2016 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Apr 5, 1994 in TX
Enrollment address
4400 I H 30 W
Ste 100
Greenville, TX 75402-4620

National Provider Directory

National Provider Directory
Tax ID family
Baylor Health Network I78 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Kevin S Liu Individual Corporate DirectorBoard Member Jul 1, 2014
Fred D Winter Individual Corporate DirectorBoard Member Jul 1, 2004
Loree J. Lieving Individual Corporate DirectorBoard Member Jul 1, 2014
Pamela Peiffer Individual Corporate OfficerVP & Cfo May 1, 2019
Catherine a Raver Individual Corporate DirectorBoard Member Oct 1, 2015
Jill Louise Studley Individual Corporate DirectorBoard Member Jul 1, 2009
Craig C Kneten Individual Corporate DirectorBoard Member Jul 1, 2014
Richard C Naftalis Individual Corporate DirectorBoard Member Jul 1, 2009
Sharon E Tucker Individual Corporate DirectorBoard Member Jul 1, 2005
Michael N Sills Individual Corporate DirectorBoard Member Jul 1, 2016
Jennifer K Zimmer Individual Corporate DirectorBoard Member Jan 24, 2014
Michael Rothkopf Individual Corporate DirectorBoard Member Jul 1, 2013
Gary V Hoss Individual Corporate DirectorBoard Member Jul 1, 2008
Howard C. Derrick Individual Corporate DirectorBoard Member Jul 1, 2003
Jane Ensey Individual Corporate DirectorBoard Member Jul 1, 2013
Charles C Risinger Individual Corporate DirectorBoard Member Jun 1, 2001
Amy J Wilson Individual Corporate DirectorBoard Member Jul 1, 2008
John W Mercer Individual Corporate DirectorBoard Member Jul 1, 2014
Alan L Jones Individual Corporate DirectorBoard Member Jul 1, 2007
Jennifer S Reeves Individual Corporate DirectorDirector Jul 1, 2017
W-2 Managing EmployeeDirector Jul 1, 2017
John a Bousquet Individual Corporate DirectorBoard Member Jul 1, 2011

Owners & managing parties with NPI records 18

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

View all 18

Change-of-ownership history 2

DateEventCounterparty
Jun 1, 2016 Change of OwnershipThis provider was the buyer Pca-GreenvilleCCN 453870, TX, NPI 1790723468
Jun 1, 2016 Change of OwnershipThis provider was the seller Pca GreenvilleCCN 453870, TX, NPI 1790723468

Practitioners & affiliated clinicians

Practitioners 6

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": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654560000000",
    "number": "1790723468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8080 N CENTRAL EXPY STE 600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752063794",
            "telephone_number": "469-800-8649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 IH 30 W",
            "address_2": "SUITE 100",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754024620",
            "telephone_number": "469-800-3524",
            "fax_number": "469-800-3564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHTEXAS PROVIDER NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "status": "A",
        "authorized_official_last_name": "HARDING",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "469-800-8500"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "091888002",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "00J629",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137940601",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137940607",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PCA GREENVILLE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PCA GREENVILLE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, TX

Sources for this page

Verify at the official NPI Registry.