NPIMap

Organization Active NPI

Su Clinica Familiar

  • Federally Qualified Health Center (FQHC)
  • Brownsville, TX
National Provider Identifier
1811901655
Registry record updated Nov 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SU CLINICA FAMILIAR
Practice address
105 E Alton Gloor Blvd
Brownsville, TX 78526-3391
Phone
(956) 831-8338
Fax
(956) 831-3285
NPI assigned
Jul 28, 2006
Last updated
Nov 19, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2012

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

Authorized official

Name
Mr. Adam Saldivar
Title
Cfo
Phone
(956) 365-6750

Specialties & licenses 1

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

Addresses

Primary practice location

105 E Alton Gloor Blvd
Brownsville, TX 78526-3391

Mailing address

1706 Treasure Hills Blvd
Harlingen, TX 78550-8911
Phone (956) 365-6750

Other identifiers 1

IdentifierTypeStateIssuer
019027401MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031017000005 TX Part A Provider - Federally Qualified Health Center (FQHC) 5496663429 Practice locations: Brownsville, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811901655. Details of each certification follow.

Federally qualified health center certification: CCN 451828

Legal name
SU CLINICA FAMILIAR
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 19, 1980 in TX
Enrollment address
105 E Alton Gloor Blvd
Brownsville, TX 78526-3391

Other NPIs with the same Medicare PAC ID 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0054590Su Clinica105 East Alton Gloor Blvd, Brownsville, TX 78526AccreditationMar 10, 2028

National Provider Directory

National Provider Directory
Tax ID family
Suclinica Familiar15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Jose Adam Saldivar Individual Corporate OfficerChief Financial Officer Dec 12, 2005
Melida Villareal Individual W-2 Managing Employee Apr 19, 2007
Elena L Marin Individual Corporate OfficerChief Executive Officer Dec 10, 2003

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Su Clinica FamiliarSanta Rosa, TX, CCN 671951 Federally qualified health center Operational/Managerial Control Jul 1, 2010

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 35

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 35

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353283200000",
    "number": "1811901655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 TREASURE HILLS BLVD",
            "city": "HARLINGEN",
            "state": "TX",
            "postal_code": "785508911",
            "telephone_number": "956-365-6750",
            "fax_number": "956-365-6779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E ALTON GLOOR BLVD",
            "city": "BROWNSVILLE",
            "state": "TX",
            "postal_code": "785263391",
            "telephone_number": "956-831-8338",
            "fax_number": "956-831-3285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SU CLINICA FAMILIAR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2012-11-19",
        "status": "A",
        "authorized_official_last_name": "SALDIVAR",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "956-365-6750",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019027401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brownsville, TX

Sources for this page

Verify at the official NPI Registry.