West Side Community Health Services, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Saint Paul, MN
NPI 1023201811 · NPPES record last updated May 15, 2024
Key facts
- NPI
- 1023201811
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- WEST SIDE COMMUNITY HEALTH SERVICES, INC.
- Practice address
- 275 Lexington Pkwy N
Saint Paul, MN 55104-5402 - Phone
- (651) 632-2194
- Fax
- (651) 632-2195
- NPI assigned
- Aug 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Reuben Moore
- Title
- Executive Director
- Phone
- (651) 602-7500
Owners & managing parties with NPI records 1
-
Mary Nesvig, MD
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 17
Other NPIs with the same Medicare PAC ID 15
Practitioners 57
-
Ana M Abugattas, LMFT
-
Nkeiru Adoga, FNP
-
Selase Adzo Agudu-Morgan, FNP-C
-
Fadumasara B Ali, NP
-
Susan Benfield, MD
-
Elaine Boehm, CNM
-
Nikala Marie Bremmer, CNM, APRN
-
Kathleen Donnelly, FNP
-
Faiza Omar Elmi, CNP
-
Augustine I Evbakhare, FNP-C
-
Madeline Gardner, APRN CNM
-
Carolina Gentry, LICSW
-
Joel Stuart Giffin, D.O.
-
Ruth Mushimbwa Haamankuli, DNP, FNP
-
Brittany Morgan Jerez, DNP, APRN, CNM
-
Steven Edward Lawrence, M.S., LMFT
-
Elise Noelle Marcotte, PA-C
-
Mehret Medhanie, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Federally qualified health center certification: CCN 241848
- Legal name
- WEST SIDE COMMUNITY HEALTH SERVICES, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 26, 2007
- Last certification
- Jan 26, 2007
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 1, 1972 in MN
- Enrollment address
- 275 Lexington Pkwy N
Saint Paul, MN 55104-5402
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Christine Singer |
Corporate Officer |
May 29, 2015 | |
| W-2 Managing Employee |
May 29, 2015 | ||
| Jeanette Jones |
Corporate Director | Nov 19, 2015 | |
| Summer Abdalla |
Corporate Director | May 7, 2018 | |
| Mary C Nesvig |
Corporate Officer |
Oct 19, 1991 | |
| Operational/Managerial Control |
Oct 19, 1991 | ||
| Peter Surdo |
Corporate Director | May 1, 2009 | |
| Roman Cress |
Corporate Director | May 7, 2018 | |
| Amelia Hardy |
Corporate Director | Jan 15, 1976 | |
| Blake Darsow |
Corporate Officer |
Aug 26, 2016 | |
| W-2 Managing Employee |
Aug 26, 2016 | ||
| William Thompson |
Corporate Director | Jul 1, 2010 | |
| Catherine Ellingson |
W-2 Managing Employee |
Jun 1, 2006 | |
| Cordell Hardy |
Corporate Director | May 7, 2018 | |
| Reuben Moore |
Corporate Officer |
Oct 3, 2017 | |
| W-2 Managing Employee |
Oct 3, 2017 | ||
| Zachary Hylton |
Corporate Director | May 7, 2018 | |
| Krisa Ryan |
Corporate Director | May 7, 2018 | |
| Andreatte E Hames |
Corporate Director | Jun 27, 2013 | |
| Janet Zastrow |
Corporate Director | May 7, 2018 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| West Side Community Health Services, Inc. |
Federally qualified health center | Operational/Managerial Control | Dec 8, 1988 |
| Creative Arts Clinic |
Federally qualified health center | Operational/Managerial Control (100%) | Nov 1, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040209000647 | MN | Part B Supplier - Clinic/Group Practice | 2062306434 |
Receives reassigned benefits from 116 practitioners 18 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Saint Paul, MN; Saint Paul Park, MN; Maplewood, MN; St. Paul, MN; Minneapolis, MN |
| O20061117000071 | MN | Part a Provider - Federally Qualified Health Center (FQHC) | 2062306434 | Practice locations: Saint Paul, MN |
National Provider Directory
Locations
1495 Rice St
Saint Paul, MN 55117
Phone (651) 487-8531
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | MN | Yes |
Addresses
Primary practice location
275 Lexington Pkwy N
Saint Paul, MN 55104-5402
Mailing address
153 Cesar Chavez St
Saint Paul, MN 55107-2226
Phone (651) 602-7500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103124 | Other | MN | UCARE |
| 542748700 | Medicaid | MN |
Other names
- Central High School Clinic
Other providers in Saint Paul, MN
- West Side Community Health Services Inc
- West Side Community Health Services Inc
- West Side Community Health Services, Inc
- West Side Community Health Services, Inc
- West Side Community Health Services, Inc
- West Side Community Health Services, Inc.
- West Side Community Health Services, Inc.
- West Side Community Health Services, Inc.
- West Side Community Health Services, Inc.
- West Side Community Health Services, Inc.
All providers in Saint Paul, MN · Federally Qualified Health Center (FQHC) in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2024. 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.