Affinia Healthcare
Organization Active NPI Federally Qualified Health Center (FQHC) · Saint Louis, MO
NPI 1003392697 · NPPES record last updated Sep 27, 2021
Key facts
- NPI
- 1003392697
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- AFFINIA HEALTHCARE
- Practice address
- 2900 Washington Ave
Saint Louis, MO 63103-1306 - Phone
- (314) 898-1700
- Fax
- (314) 814-8542
- NPI assigned
- Jul 17, 2018
- Organization subpart
- No
Authorized official
- Name
- Corinthia Darcel Jamison
- Title
- Credentialing Coordinator
- Phone
- (314) 814-8531
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 20
Facilities with the same owner 1
Practitioners 30
-
Allison Andrelchik, MSW
-
Alexa Arastoo, DO
-
Mihiret M Belihu, M.D.
-
Mahamaya Bhattacharyya, M.D.
-
Sara Frankowski, MD
-
Mary Bridget Keegan, M.D.
-
Jevinne Khan, DC
-
Barbara A Lutey, MD
-
Timothy J McCann, MD
-
Manuela Mejia, MD
-
David Almon Miller, M.D.
-
Steven Phillip Mishkin, L.C.S.W.
-
Catherine Ruth Moore, D.O.
-
Tareq I. Nabhan, O.D.
-
Jessica Norton, M.D.
-
Vani Pachalla, M.D.
-
Amy Schaag, O.D.
-
Margaret L Shields, D.P.M.
-
Theodore K. Sullivan, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
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
- Corporation · Non-profit
- Incorporated
- Aug 24, 2022 in MO
- Enrollment address
- 2900 Washington Ave
Ste 100
Saint Louis, MO 63103-1389
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Araceli Escalante-Gudino |
Corporate Officer | Jan 1, 2022 | |
| Riisa Rawlins |
Corporate Officer | Jan 1, 2022 | |
| Kevin Hachegechog |
Corporate Officer | Jan 1, 2022 | |
| Robert Jacobson |
Corporate Officer | Jan 1, 2022 | |
| Debra Johns |
Corporate Officer | Jan 1, 2022 | |
| Kimball McMullin |
Corporate Officer |
Jan 1, 2022 | |
| Georgia Harris |
Corporate Officer | Jan 1, 2022 | |
| David Walters |
Corporate Officer |
Jan 1, 2022 | |
| Jean M Frazee |
Corporate Officer | Jan 1, 2022 | |
| Laurel Tinsley |
Corporate Officer | Jan 1, 2022 | |
| Tondaleria Curry |
Corporate Officer | Jan 1, 2022 | |
| Janet L Voss |
Corporate Director |
Apr 1, 2016 | 100% |
| Mitchell L Baris |
Corporate Officer | Jan 1, 2022 | |
| Carrollton Bank |
5% Or Greater Direct Ownership Interest | Aug 24, 2022 | 36.6% |
| Gwendolyn Hall |
Corporate Officer | Jan 1, 2022 | |
| Alan O Freeman |
Corporate Director |
Nov 14, 2006 | 100% |
| W-2 Managing Employee |
Nov 14, 2006 | 5% | |
| Paula R Davis |
Corporate Officer | Jan 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220927002122 | MO | Part a Provider - Federally Qualified Health Center (FQHC) | 1052386919 | Practice locations: Saint Louis, MO |
National Provider Directory
- Tax ID family
- Affinia Healthcare
Locations
2900 Washington Ave
Saint Louis, MO 63103
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
- Salvation Army
Other providers in Saint Louis, MO
- Aegis Homecare LLC
- Aesthetic and Hand Surgery
- Aesthetic Dermatologic Surgery
- Aesthetic Medical Associates, LLC
- Aesthetic Surgery Associates Inc
- Affinia Healthcare
- Affinia Healthcare
- Affinia Healthcare
- Affinia Healthcare
- Affinia Healthcare
All providers in Saint Louis, MO · Federally Qualified Health Center (FQHC) in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.