Active NPI
Healthcore Clinic Inc
- Federally Qualified Health Center (FQHC)
- Wichita, KS
National Provider Identifier
1033218565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Federally Qualified Health Center (FQHC)
- License
- 1033218565
- Legal business name
- HEALTHCORE CLINIC INC
- Practice address
- 2707 East 21St Street North
Wichita, KS 67214-2249 - Phone
- (316) 691-0249
- Fax
- (316) 691-9939
- NPI assigned
- Sep 21, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Teresa Lovelady
- Title
- Ceo
- Phone
- (316) 691-0249
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 1033218565 | KS | Primary |
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | 07000887 | KS | |
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | 07000882 | KS |
Addresses
Primary practice location
2707 East 21St Street North
Wichita, KS 67214-2249
Mailing address
2707 East 21St Street North
Wichita, KS 67214-2249
Phone (316) 691-0249
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100321990 | Medicaid | KS | |
| 100321990C | Medicaid | KS | |
| 100321990A | Medicaid | KS |
Other names 1
- Center for Health and Wellness
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031111000669 | KS | Part B Supplier - Clinic/Group Practice | 9739092131 |
Receives reassigned benefits from 29 practitioners Practice locations: Wichita, KS |
| O20090702000064 | KS | Part A Provider - Federally Qualified Health Center (FQHC) | 9739092131 | Practice locations: Wichita, KS |
Federally qualified health center certification: CCN 171830
- Legal name
- HEALTHCORE CLINIC INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 2, 2009
- Last certification
- Jul 2, 2009
- Ownership / control type
- Non-profit – church related
- Organization structure
- Corporation
- Incorporated
- Jun 7, 1996 in KS
- Enrollment address
- 2707 E 21St St N
Wichita, KS 67214-2249
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 1
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Teresa Lovelady | Corporate Officer | Mar 7, 2011 | |
| Corporate Director | Jan 14, 2011 | 100% | |
| W-2 Managing Employee | Jan 1, 2011 | ||
| Operational/Managerial Control | Mar 7, 2011 |
Practitioners & affiliated clinicians
Practitioners 31
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1439510400000",
"number": "1033218565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2707 EAST 21ST STREET NORTH",
"city": "WICHITA",
"state": "KS",
"postal_code": "672142249",
"telephone_number": "316-691-0249",
"fax_number": "316-691-9939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2707 EAST 21ST STREET NORTH",
"city": "WICHITA",
"state": "KS",
"postal_code": "672142249",
"telephone_number": "316-691-0249",
"fax_number": "316-691-9939"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HEALTHCORE CLINIC INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-21",
"last_updated": "2015-08-14",
"status": "A",
"authorized_official_last_name": "LOVELADY",
"authorized_official_first_name": "TERESA",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "316-691-0249",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "261QF0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
"state": "KS",
"license": "1033218565",
"primary": true
},
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": "KS",
"license": "07000887",
"primary": false
},
{
"code": "261QR0405X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
"state": "KS",
"license": "07000882",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100321990",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100321990C",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100321990A",
"state": "KS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Center for Health and Wellness",
"code": "4",
"type": "Former Legal Business Name"
}
]
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.