NPIMap

Organization Active NPI

Heart of Texas Community Health Center, Inc

Doing business as MacArthur Pediatric Clinic

  • Federally Qualified Health Center (FQHC)
  • Waco, TX
National Provider Identifier
1861880080
Registry record updated Jul 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC
Doing business as
MacArthur Pediatric Clinic
Practice address
1600 Providence Dr
Waco, TX 76707-2261
Phone
(254) 313-4200
Fax
(254) 313-4326
NPI assigned
Dec 23, 2014
Last updated
Jul 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2017

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

Authorized official

Name
Mrs. Annette Ballew, CPA
Title
Cfo
Phone
(254) 313-4282

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Pediatrics Physician 208000000X

Addresses

Primary practice location

1600 Providence Dr
Waco, TX 76707-2261

Mailing address

2201 Macarthur Dr
Suite 103
Waco, TX 76708-3161
Phone (254) 313-4200

Other identifiers 1

IdentifierTypeStateIssuer
345098301MedicaidTX

Other names 1

  • MacArthur Pediatric Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150224001573 TX Part A Provider - Federally Qualified Health Center (FQHC) 1153370242 Practice locations: Waco, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861880080. Details of each certification follow.

Federally qualified health center certification: CCN 741880

Legal name
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
Doing business as
WACO FAMILY MEDICINE - MACARTHUR
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 24, 2015
Last certification
Feb 24, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 15, 1998 in TX
Enrollment address
2201 Macarthur Dr
Ste 103
Waco, TX 76708-3159

Other NPIs with the same Medicare PAC ID 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Heart of Texas Community Health Center30 organizations share this tax ID, including this one

Other organizations with this tax ID 29

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

View all 29

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Kristen Padilla-Manor Individual Corporate Director Apr 22, 2019
Donald M Hardin Individual Corporate OfficerChief Clinical Officer May 10, 2021
Mildred Watley Individual Corporate Director Jul 19, 2021
Sherry Williams Individual Corporate Director Apr 22, 2019
Matthew Polk Individual Corporate OfficerChief Operating Officer Oct 1, 2020
Gloria Guerra Individual Corporate Director Jun 1, 2019
George Johnson Individual Corporate Director Nov 13, 2017
Tashita Bibles Individual Corporate Director Jul 19, 2021
William Clifton Individual Corporate Director Oct 26, 2015
Delia Anzaldua-Rivera Individual Corporate Director Dec 12, 2016
Annette Ballew Individual Corporate OfficerCfo May 8, 2015
W-2 Managing Employee Jun 30, 1998
Crisala Houston Individual Corporate OfficerCompliance & Equity Officer Feb 1, 2021
Hector Sabido Individual Corporate Director Aug 30, 2021
Dale Barron Individual Corporate OfficerChief Advancement Officer Jun 29, 2015
Mark Hobbs Individual Corporate Director Apr 22, 2019
Jackson O Griggs Individual Corporate OfficerChief Executive Officer Feb 25, 2019

Owners & managing parties with NPI records 2

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
Waco Family Medicine - Madison CooperWaco, TX, CCN 671013 Federally qualified health center Operational/Managerial Control (100%) Jun 1, 2012

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1419292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501200000000",
    "number": "1861880080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 MACARTHUR DR",
            "address_2": "SUITE 103",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767083161",
            "telephone_number": "254-313-4200",
            "fax_number": "254-313-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 PROVIDENCE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767072261",
            "telephone_number": "254-313-4200",
            "fax_number": "254-313-4326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART OF TEXAS COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-23",
        "last_updated": "2017-07-28",
        "status": "A",
        "authorized_official_last_name": "BALLEW",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "254-313-4282",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "345098301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MacArthur Pediatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.