NPIMap

Organization Active NPI

Affinia Healthcare

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
National Provider Identifier
1013925890
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
500899596 Issued in MO
Legal business name
AFFINIA HEALTHCARE
Practice address
3930 S Broadway
Saint Louis, MO 63118-4626
Phone
(314) 577-6232
Fax
(314) 814-8542
NPI assigned
Aug 4, 2006
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
Mrs. Janet Voss
Title
Cfo
Phone
(314) 814-8571

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 500899596 MO Primary

Addresses

Primary practice location

3930 S Broadway
Saint Louis, MO 63118-4626

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
500899596MedicaidMO
26D0983729OtherCLIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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
O20051019000204 MO Part A Provider - Federally Qualified Health Center (FQHC) 1052386919 Practice locations: Saint Louis, MO

Federally qualified health center certification: CCN 261896

Legal name
AFFINIA HEALTHCARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 14, 2005
Last certification
Nov 14, 2005
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 26, 1998 in MO
Enrollment address
3930 S Broadway
Saint Louis, MO 63118-4626

All disclosed owners & managing parties 19

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, 2020
Riisa Rawlins Individual Corporate Officer Jan 1, 2020
Mary Dambrose Individual Corporate Officer Jan 1, 2018
Kevin Hachegechog Individual Corporate Officer Jan 1, 2020
Vickie J Lomax Individual Corporate DirectorBoard Member Jan 1, 2015
Robert Jacobson Individual Corporate OfficerChairman Jan 1, 2015
Debra Johns Individual Corporate DirectorBoard Member Jan 1, 2015
Kimball McMullin Individual Corporate Director Jan 1, 2014
Georgia Harris Individual Corporate Officer Jan 1, 2018
David Walters Individual Corporate Officer Jan 1, 2020
Jean M Frazee Individual Corporate OfficerTreasurer Jan 1, 2014
Laurel Tinsley Individual Corporate DirectorBoard Chair Jan 1, 2021
Tondaleria Curry Individual Corporate DirectorBoard Member Jan 1, 2015
Janet L Voss Individual Corporate OfficerVP/Cfo Apr 1, 2016 100%
Operational/Managerial ControlVP/Cfo Apr 1, 2016 100%
Mitchell L Baris Individual Corporate OfficerVice Chair Jan 1, 2014
Gwendolyn Hall Individual Corporate Officer Jan 1, 2018
Alan O Freeman Individual Corporate DirectorCeo/President Nov 13, 2006 100%
W-2 Managing EmployeeCeo/President Nov 13, 2006 100%
Paula R Davis Individual Corporate DirectorBoard Member Jan 1, 2015
Gilbert Peoples Individual Corporate OfficerSecretary Jan 1, 2018

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

3930 S Broadway
Saint Louis, MO 63118
Phone (314) 577-6232

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 7

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

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1013925890",
    "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": "3930 S BROADWAY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631184626",
            "telephone_number": "314-577-6232",
            "fax_number": "314-814-8542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFINIA HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "VOSS",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "314-814-8571",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MO",
            "license": "500899596",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500899596",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26D0983729",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.