NPIMap

Organization Active NPI

Amistad Community Health Center Incorporated

Doing business as Amistad Health

  • Federally Qualified Health Center (FQHC)
  • Robstown, TX
National Provider Identifier
1831720176
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
AMISTAD COMMUNITY HEALTH CENTER INCORPORATED
Doing business as
Amistad Health
Practice address
814 E Main Ave
Robstown, TX 78380-3135
Phone
(361) 884-2242
NPI assigned
Jan 27, 2020
Last updated
Apr 3, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
AMISTAD COMMUNITY HEALTH CENTER INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Authorized official

Name
Clara Talia Peterson
Title
Cfo
Phone
(361) 886-3066

Specialties & licenses 1

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

Addresses

Primary practice location

814 E Main Ave
Robstown, TX 78380-3135

Mailing address

1533 S Brownlee Blvd
Corpus Christi, TX 78404-3131
Phone (361) 884-2242

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidTX

Other names 1

  • Amistad Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200309002282 TX Part A Provider - Federally Qualified Health Center (FQHC) 8527131036 Practice locations: Robstown, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831720176. Details of each certification follow.

Federally qualified health center certification: CCN 451103

Legal name
AMISTAD COMMUNITY HEALTH CENTER INCORPORATED
Doing business as
RCM360 LLC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 5, 2020
Last certification
Mar 5, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 16, 2005 in TX
Enrollment address
814 E Main Ave
Robstown, TX 78380-3135

Other NPIs with the same Medicare PAC ID 6

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
45D2181059Amistad Community Health Center Inx814 E Main Ave, Robstown, TX 78380Certificate of waiverMar 24, 2028

National Provider Directory

National Provider Directory
Tax ID family
Amistad Comm HLTH Ctr Inc8 organizations share this tax ID, including this one
Part of
Amistad Comm HLTH Ctr Inc

Other organizations with this tax ID 7

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

Locations

1533 S Brownlee Blvd
Ste 100
Corpus Christi, TX 78404
Phone (361) 884-2242

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
Steven Leon Gates Individual Corporate DirectorBoard Member Feb 1, 2019
William Larsen Individual Corporate DirectorVice President- Board Member Dec 1, 2014
Melissa L. Ramsden Individual Corporate DirectorBoard Member Feb 1, 2015
Esther Jones Individual Corporate DirectorBoard Member Feb 1, 2019
W-2 Managing EmployeeHR Director Jan 20, 2025
Jason Darrow Individual W-2 Managing EmployeeCfo Jan 1, 2025
Amistad Community Health Center Incorporated Organization, Robstown, TX Corporation, Non-profit Operational/Managerial Control Jan 1, 2020
Carole Devos Individual Contracted Managing EmployeeContracting Manager Dec 1, 2008 4%
Eric Baggerman Individual Corporate OfficerCeo Feb 1, 2021
W-2 Managing EmployeeCeo Feb 1, 2021

Owners & managing parties with NPI records 8

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
Amistad Community Health Center IncorporatedAransas Pass, TX, CCN 451164 Federally qualified health center Operational/Managerial Control Nov 1, 2021

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": "1580083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743638400000",
    "number": "1831720176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1533 S BROWNLEE BLVD",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784043131",
            "telephone_number": "361-884-2242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "814 E MAIN AVE",
            "city": "ROBSTOWN",
            "state": "TX",
            "postal_code": "783803135",
            "telephone_number": "361-884-2242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMISTAD COMMUNITY HEALTH CENTER INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMISTAD COMMUNITY HEALTH CENTER INCORPORATED",
        "enumeration_date": "2020-01-27",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "CLARA",
        "authorized_official_middle_name": "TALIA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "361-886-3066"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Amistad Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Robstown, TX

Sources for this page

Verify at the official NPI Registry.