NPIMap

Organization Active NPI

El Centro del Barrio, Inc

Doing business as CentroMed Indian Creek Clinic

  • Federally Qualified Health Center (FQHC)
  • San Antonio, TX
National Provider Identifier
1801389044
Registry record updated Jan 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EL CENTRO DEL BARRIO, INC
Doing business as
CentroMed Indian Creek Clinic
Practice address
5439 Ray Ellison Blvd
San Antonio, TX 78242-2219
Phone
(210) 922-7000
Fax
(210) 457-3392
NPI assigned
Jun 12, 2018
Last updated
Jan 30, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2019

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

Authorized official

Name
Mr. Lawrence C Walzel, CPA, MBA
Title
VP/Cfo
Phone
(210) 334-3724

Specialties & licenses 1

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

Addresses

Primary practice location

5439 Ray Ellison Blvd
San Antonio, TX 78242-2219

Mailing address

3750 Commercial Ave
San Antonio, TX 78221-3117
Phone (210) 922-7000

Other names 1

  • CentroMed Indian Creek Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181106000885 TX Part A Provider - Federally Qualified Health Center (FQHC) 6800881285 Practice locations: San Antonio, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801389044. Details of each certification follow.

Federally qualified health center certification: CCN 451022

Legal name
EL CENTRO DEL BARRIO INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 5, 2018
Last certification
Nov 5, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 14, 1973 in TX
Enrollment address
5439 Ray Ellison Blvd
San Antonio, TX 78242-2219

Other NPIs with the same Medicare PAC ID 20

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

View all 20

National Provider Directory

National Provider Directory
Tax ID family
El Centro del Barrio in37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

Locations

1034 W County Line Rd
New Braunfels, TX 78130
Phone (830) 606-9900

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Melinda Perez Individual Corporate DirectorBoard Member Jan 28, 2021
Donald J Macaulay Individual Corporate DirectorVP/Coo Feb 20, 1995
W-2 Managing EmployeeVP/Coo Feb 20, 1995
Ricardo Perez Individual Corporate DirectorBoard Member Mar 19, 2009
Diana M Torres Individual Corporate DirectorBoard Member Jun 30, 1994
Elsa Gambo Individual Corporate DirectorBoard Member Jan 23, 2020
Juan a Chavira Individual Corporate DirectorBoard Member May 22, 2006
Rudy Pena Individual Corporate DirectorBoard Member Sep 1, 2011
Noemi G Eling Individual Corporate DirectorBoard Member Feb 27, 1992
Heriberto Guerra Individual Corporate DirectorBoard Member Jan 28, 1999
Luz M Cano Individual Corporate DirectorBoard Member Apr 2, 2015
Lawrence Charles Walzel Individual Corporate DirectorVP & Cfo Feb 16, 1998
W-2 Managing EmployeeVP/Cfo Feb 16, 1998
Nicolas Jr Rangel Individual Corporate DirectorBoard Member Mar 23, 2017
Norma L Green Individual Corporate DirectorBoard Member Jun 27, 1991
Ernesto Gomez Individual Corporate DirectorPresident & Ceo Jun 1, 1973
W-2 Managing EmployeePresident & Ceo Jun 1, 1973
Arlene James Brown Individual Corporate DirectorBoard Member Mar 14, 2019
Lorraine Alaniz Individual Corporate DirectorBoard Member Jun 24, 2021
Elsa I Martinez Individual Corporate DirectorBoard Member Jun 26, 2014

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Centromed City Center ClinicSan Antonio, TX, CCN 451166 Federally qualified health center Operational/Managerial Control Jan 3, 2022

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 10

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": "1528761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548806400000",
    "number": "1801389044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3750 COMMERCIAL AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782213117",
            "telephone_number": "210-922-7000",
            "fax_number": "210-457-3392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5439 RAY ELLISON BLVD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782422219",
            "telephone_number": "210-922-7000",
            "fax_number": "210-457-3392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL CENTRO DEL BARRIO, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-12",
        "last_updated": "2019-01-30",
        "status": "A",
        "authorized_official_last_name": "WALZEL",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "210-334-3724",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA, MBA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CentroMed Indian Creek Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.