Kickapoo Traditional Tribe of Texas

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

KICKAPOO TRADITIONAL TRIBE OF TEXAS

Practice address

2192 Rosita Valley Road
Eagle Pass, TX 78852-9752

Phone

(830) 421-5349

Fax

(830) 757-5193

NPI assigned

Dec 13, 2006

Organization subpart

No

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

Authorized official

Name

Cynthia Rivera

Title

Office Manager

Phone

(830) 421-5926

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Texas Band of Kickapoo Former legal business name

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

Federally qualified health center certification: CCN 451026

Legal name

KICKAPOO TRADITIONAL TRIBE OF TEXAS

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Nov 28, 2018

Last certification

Nov 28, 2018

Ownership / control type

For profit – corporation

Facility address

2192 Rosita Valley Road
Eagle Pass, TX 78852

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jorge Alejandro Barboza Sosa, M.D.

  • Internal Medicine Physician
  • Eagle Pass, TX
  • NPI 1437203437
  Medicare reassignment Care Compare group NPD
• Victoriano Valdez, MD

  • Internal Medicine Physician
  • Eagle Pass, TX
  • NPI 1982682225
  Medicare reassignment Care Compare group NPD
• Barbara Rokya Fussnecker, MSN, APRN, FNP-C

  • Family Nurse Practitioner
  • Eagle Pass, TX
  • NPI 1831081561
  Medicare reassignment NPD
• Jacqueline Heredia Gracia, M.D.

  • Pediatrics Physician
  • Eagle Pass, TX
  • NPI 1275858227
  Medicare reassignment NPD
• Jesus Chavez

  • Mental Health Counselor
  • Eagle Pass, TX
  • NPI 1316579782
  NPD (past)
• Christopher Liang, D.M.D.

  • Dentist
  • Los Alamitos, CA
  • NPI 1144695289
  NPD (past)

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773792000000",
    "number": "1821159518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2192 ROSITA VALLEY RD",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788522542",
            "telephone_number": "830-421-5930",
            "fax_number": "830-752-6033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2192 ROSITA VALLEY ROAD",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788529752",
            "telephone_number": "830-421-5349",
            "fax_number": "830-757-5193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KICKAPOO TRADITIONAL TRIBE OF TEXAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "830-421-5926"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "HSZ222",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200158801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Texas Band of Kickapoo",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Texas Band of Kickapoo",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Jose Riojas Jr OD PC
• JRP Therapy Care PLLC
• K. West PHC LLC
• Monica Rae Kessler, PAC
• Keywest Adult Day Care
• Kennard Lee Kollaus, M.D.
• Kypuros Enterprises LLC
• La Guadalupana Adult Day Care, Inc.
• La Guadalupana Primary Home Care, LLC
• La Guadalupana Primary Home Care, LLC

• Health Service Clinic/Center in Eagle Pass, TX
• Providers in Eagle Pass, TX by specialty
• Health Service Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.