NPIMap

Organization Active NPI

Stephen F Austin Community Health Center, Inc

Doing business as Mychn Pasadena

  • Federally Qualified Health Center (FQHC)
  • Pasadena, TX
National Provider Identifier
1962189407
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC
Doing business as
Mychn Pasadena
Practice address
6243 Fairmont Pkwy Ste 203&204
Pasadena, TX 77505-4045
Phone
(281) 824-1480
Fax
(281) 220-6407
NPI assigned
Jun 28, 2023
Last updated
Mar 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Authorized official

Name
Brandy Smith
Title
Credentialing Coordinator II
Phone
(281) 824-1480

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

6243 Fairmont Pkwy Ste 203&204
Pasadena, TX 77505-4045

Mailing address

1612 Callaway Dr
Alvin, TX 77511-3743
Phone (281) 824-1480

Other practice location 1

10851 Scarsdale Blvd Ste 160
Houston, TX 77089-5737
Phone (281) 824-1480

Other practice location 2

1111 W Adoue St
Alvin, TX 77511-2718
Phone (281) 824-1480

Other names 1

  • MYCHN PASADENA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240528002682 TX Part A Provider - Federally Qualified Health Center (FQHC) 6204977127 Practice locations: Pasadena, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962189407. Details of each certification follow.

Federally qualified health center certification: CCN 971010

Legal name
STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC.
Doing business as
MYCHN PASADENA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 24, 2024
Last certification
Jun 24, 2024
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Aug 31, 2023 in TX
Enrollment address
6243 Fairmont Pkwy
Ste 203 & 204
Pasadena, TX 77505-4047

Other NPIs with the same Medicare PAC ID 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
CHN Pharmacy28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

Locations

6243 Fairmont Pkwy
Ste 203204
Pasadena, TX 77505
Phone (281) 487-3111

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Marbella Hooper Individual 5% Or Greater Indirect Ownership InterestSecretary of the Board Aug 1, 2017
Corporate DirectorSecretary of the Board Aug 1, 2017
Brandy Smith Individual W-2 Managing EmployeeCredentialing Specialist Apr 7, 2016
Mark Young Individual 5% Or Greater Direct Ownership InterestCeo Apr 1, 2010
5% Or Greater Indirect Ownership InterestCeo Apr 1, 2010
Corporate OfficerCheif Executive Officer Apr 1, 2010
Operational/Managerial ControlCeo Apr 1, 2010
Gilberto Romero Individual 5% Or Greater Indirect Ownership InterestMember of the Board Dec 16, 2019
Corporate DirectorMember of the Board Dec 16, 2019
Cheryl Sellers Individual 5% Or Greater Indirect Ownership InterestMember of the Board Oct 21, 2020
Corporate DirectorMember of the Board Oct 21, 2020
Debra Fontenot Individual 5% Or Greater Indirect Ownership InterestMember of the Board Aug 21, 2018
Corporate DirectorMember of the Board Aug 21, 2018
Adam Martinez Individual 5% Or Greater Indirect Ownership InterestMember of the Board Nov 15, 2023
Corporate DirectorMember of the Board Nov 15, 2023
Andrea Nguyen Individual 5% Or Greater Indirect Ownership InterestMember of the Board Oct 18, 2023
Corporate DirectorMember of the Board Oct 18, 2023
Bonnie Horton Individual 5% Or Greater Indirect Ownership InterestMember of the Board Apr 8, 2008
Corporate DirectorMember of the Board Apr 8, 2008
Cornelia Jammer Individual 5% Or Greater Indirect Ownership InterestTreasurer of the Board Feb 19, 2019
Corporate DirectorTreasurer of the Board Feb 19, 2019
Gerald Roznovsky Individual 5% Or Greater Indirect Ownership InterestChairman of the Board Apr 8, 2008
Corporate DirectorChairman of the Board Apr 8, 2008
Gina Adams Individual 5% Or Greater Indirect Ownership InterestVice Chairman of the Board Jan 1, 2015
Corporate DirectorVice Chairman of the Board Jan 1, 2015
Isabel Sanchez Individual 5% Or Greater Indirect Ownership InterestMember of the Board Dec 16, 2019
Corporate DirectorMember of the Board Dec 16, 2019

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Stephen F Austin Community Health Center, Inc.Alvin, TX, CCN 671934 Federally qualified health center Operational/Managerial Control Nov 24, 2009
Mychn CallawayAlvin, TX, CCN 741976 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2017
Women and Children's Health CenterAlvin, TX, CCN 451000 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 3, 2016
Pearland Family Health CenterPearland, TX, CCN 451039 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 9, 2018
Mychn WebsterWebster, TX, CCN 971091 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 16, 2017

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1687910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1962189407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 CALLAWAY DR",
            "city": "ALVIN",
            "state": "TX",
            "postal_code": "775113743",
            "telephone_number": "281-824-1480",
            "fax_number": "281-220-6407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6243 FAIRMONT PKWY STE 203&204",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775054045",
            "telephone_number": "281-824-1480",
            "fax_number": "281-220-6407"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10851 Scarsdale Blvd Ste 160",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770895737",
            "country_code": "US",
            "telephone_number": "281-824-1480",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1111 W Adoue St",
            "address_purpose": "LOCATION",
            "city": "Alvin",
            "state": "TX",
            "postal_code": "775112718",
            "country_code": "US",
            "telephone_number": "281-824-1480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-28",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR II",
        "authorized_official_telephone_number": "281-824-1480"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MYCHN PASADENA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pasadena, TX

Sources for this page

Verify at the official NPI Registry.