Affinia Healthcare
Organization Active NPI Federally Qualified Health Center (FQHC) · Saint Louis, MO
NPI 1003824293 · NPPES record last updated Sep 12, 2023
Key facts
- NPI
- 1003824293
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 507276004 (MO)
- Legal business name
- AFFINIA HEALTHCARE
- Practice address
- 2220 Lemp Ave
Saint Louis, MO 63104-2700 - Phone
- (314) 814-8514
- Fax
- (314) 814-8542
- NPI assigned
- Aug 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Janet Voss
- Title
- Cfo
- Phone
- (314) 814-8571
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 20
Practitioners 34
-
Sara Frankowski, MD
-
Jevinne Khan, DC
-
David Almon Miller, M.D.
-
Steven Phillip Mishkin, L.C.S.W.
-
Allison Andrelchik, MSW
-
Alexa Arastoo, DO
-
Mihiret M Belihu, M.D.
-
Mahamaya Bhattacharyya, M.D.
-
Mary Bridget Keegan, M.D.
-
Barbara A Lutey, MD
-
Timothy J McCann, MD
-
Manuela Mejia, MD
-
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 (2 enrollments) in MO
Federally qualified health center certification: CCN 261889
- Legal name
- AFFINIA HEALTHCARE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 25, 2005
- Last certification
- Oct 25, 2005
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 26, 1998 in MO
- Enrollment address
- 2220 Lemp Ave
Saint Louis, MO 63104-2700
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Sreeniyasa R Dandamudi |
Corporate Officer |
Jan 1, 2014 | |
| Vickie J Lomax |
Corporate Director | Oct 20, 2005 | |
| Robert Jacobson |
Corporate Director | Oct 20, 2005 | |
| Debra Johns |
Corporate Director |
Jan 1, 2015 | |
| Brenda D Corona |
Corporate Officer |
Jan 1, 2014 | |
| Kimball McMullin |
Corporate Director | Jan 1, 2014 | |
| Sherry Young |
Corporate Officer |
Jan 1, 2014 | |
| Jean M Frazee |
Corporate Director | Oct 20, 2005 | |
| Tondaleria Curry |
Corporate Officer |
Jan 1, 2014 | |
| Janet L Voss |
Corporate Officer |
Apr 1, 2016 | 100% |
| Operational/Managerial Control |
Apr 1, 2016 | 100% | |
| Mitchell L Baris |
Corporate Director | Oct 20, 2005 | |
| Alan O Freeman |
Corporate Officer |
Nov 13, 2006 | 100% |
| W-2 Managing Employee |
Nov 13, 2006 | 100% | |
| Paula R Davis |
Corporate Officer |
Jan 1, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040902000048 | MO | Part B Supplier - Clinic/Group Practice | 1052386919 |
Receives reassigned benefits from 90 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Saint Louis, MO |
| O20051020000343 | MO | Part a Provider - Federally Qualified Health Center (FQHC) | 1052386919 | Practice locations: Saint Louis, MO |
National Provider Directory
- Tax ID family
- Affinia Healthcare
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 507276004 | MO | Yes |
Addresses
Primary practice location
2220 Lemp Ave
Saint Louis, MO 63104-2700
Mailing address
PO Box 551
Saint Louis, MO 63188-0551
Phone (314) 898-1700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 507276004 | Medicaid | MO | |
| 26D1046059 | Other | MO | CLIA |
Other providers in Saint Louis, MO
- 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
- 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 12, 2023. 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.