NPIMap

Organization Active NPI

Affinia Healthcare

Doing business as Salvation Army

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
National Provider Identifier
1003392697
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
AFFINIA HEALTHCARE
Doing business as
Salvation Army
Practice address
2900 Washington Ave
Saint Louis, MO 63103-1306
Phone
(314) 898-1700
Fax
(314) 814-8542
NPI assigned
Jul 17, 2018
Last updated
Sep 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

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

Authorized official

Name
Corinthia Darcel Jamison
Title
Credentialing Coordinator
Phone
(314) 814-8531

Specialties & licenses 1

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

Addresses

Primary practice location

2900 Washington Ave
Saint Louis, MO 63103-1306

Mailing address

PO Box 551
Saint Louis, MO 63188-0551
Phone (314) 898-1700

Other names 1

  • Salvation Army Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220927002122 MO Part A Provider - Federally Qualified Health Center (FQHC) 1052386919 Practice locations: Saint Louis, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003392697. Details of each certification follow.

Federally qualified health center certification: CCN 261922

Legal name
AFFINIA HEALTHCARE
Doing business as
SALVATION ARMY MIDTOWN SERVICE AND TREATMENT CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 27, 2022
Last certification
Sep 27, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 24, 2022 in MO
Enrollment address
2900 Washington Ave
Ste 100
Saint Louis, MO 63103-1389

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Affinia Healthcare21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

2900 Washington Ave
Saint Louis, MO 63103

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Araceli Escalante-Gudino Individual Corporate Officer Jan 1, 2022
Riisa Rawlins Individual Corporate Officer Jan 1, 2022
Kevin Hachegechog Individual Corporate Officer Jan 1, 2022
Robert Jacobson Individual Corporate Officer Jan 1, 2022
Debra Johns Individual Corporate Officer Jan 1, 2022
Kimball McMullin Individual Corporate OfficerChair Jan 1, 2022
Georgia Harris Individual Corporate Officer Jan 1, 2022
David Walters Individual Corporate OfficerVice Chair Jan 1, 2022
Jean M Frazee Individual Corporate Officer Jan 1, 2022
Laurel Tinsley Individual Corporate Officer Jan 1, 2022
Tondaleria Curry Individual Corporate Officer Jan 1, 2022
Janet L Voss Individual Corporate DirectorCfo/VP Apr 1, 2016 100%
Mitchell L Baris Individual Corporate Officer Jan 1, 2022
Carrollton Bank Organization, Saint Louis, MO Created for acquisition, Financial institution 5% Or Greater Direct Ownership Interest Aug 24, 2022 36.6%
Gwendolyn Hall Individual Corporate Officer Jan 1, 2022
Alan O Freeman Individual Corporate DirectorCeo/President Nov 14, 2006 100%
W-2 Managing EmployeeCeo/President Nov 14, 2006 5%
Paula R Davis Individual Corporate Officer Jan 1, 2022

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

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": "1531785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1003392697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631880551",
            "telephone_number": "314-898-1700",
            "fax_number": "314-814-8542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 WASHINGTON AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631031306",
            "telephone_number": "314-898-1700",
            "fax_number": "314-814-8542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFINIA HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-17",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "JAMISON",
        "authorized_official_first_name": "CORINTHIA",
        "authorized_official_middle_name": "DARCEL",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "314-814-8531"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Salvation Army",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Salvation Army",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.