NPIMap

Organization Active NPI

Northwest Health Services Inc

Doing business as Cainsville Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Cainsville, MO
National Provider Identifier
1053433920
Registry record updated Nov 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHWEST HEALTH SERVICES INC
Doing business as
Cainsville Medical Clinic
Practice address
707 Victory Lane
Cainsville, MO 64632
Phone
(660) 893-5750
Fax
(660) 893-5751
NPI assigned
Apr 4, 2007
Last updated
Nov 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Matt Younger
Title
Ceo
Phone
(816) 232-6818

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

707 Victory Lane
Cainsville, MO 64632

Mailing address

707 Victory Lane
Cainsville, MO 64632
Phone (660) 893-5750

Other identifiers 1

IdentifierTypeStateIssuer
506065309MedicaidMO

Other names 1

  • Cainsville Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030103000010 MO Part A Provider - Federally Qualified Health Center (FQHC) 7113835174 Practice locations: Cainsville, MO
O20040720001347 MO Part B Supplier - Clinic/Group Practice 7113835174 Receives reassigned benefits from 24 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gower, MO; Savannah, MO; Saint Joseph, MO; King City, MO; Hamilton, MO; Braymer, MO; Chillicothe, MO; Cainsville, MO…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053433920. Details of each certification follow.

Federally qualified health center certification: CCN 261865

Legal name
NORTHWEST HEALTH SERVICES INC
Doing business as
CAINSVILLE MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 2002
Last certification
Jul 1, 2002
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 1, 1983 in MO
Enrollment address
707 Victory LN
Cainsville, MO 64632-9506
Related CCNs
261845

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 16

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

View all 16

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0946532Cainsville Medical Clinic Inc707 Victory Lane, Cainsville, MO 64632Certificate of waiverMay 27, 2028

National Provider Directory

National Provider Directory
Tax ID family
Northwest Health Services21 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

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kimberly Ireland Individual Corporate DirectorBoard of Directors Member Mar 2, 2010 100%
Terry Steinbecker Individual Corporate DirectorBoard of Directors Member Mar 2, 2010 100%
Elizabeth Blakley Individual W-2 Managing EmployeeBoard of Directors Member Mar 2, 2010 100%
Debbie Smith Individual Corporate DirectorBoard of Directors Member Mar 2, 2010 100%
Steve Loucks Individual Corporate DirectorBoard Member Jan 1, 2014 100%
Harold Johnson Individual Corporate DirectorBoard of Directors Member Mar 2, 2010 100%
Tina R Taylor Individual Corporate OfficerCfo Mar 1, 2016 100%
W-2 Managing EmployeeInterim Cfo Mar 1, 2016 100%
Robin Moppin Individual W-2 Managing EmployeeBilling & Coding Manager Feb 1, 2020 100%
Operational/Managerial ControlBilling & Coding Manager Feb 1, 2020 100%
Fiona Jacobs Individual Corporate DirectorBoard of Directors Member Mar 2, 2010 100%

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636502400000",
    "number": "1053433920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 VICTORY LANE",
            "city": "CAINSVILLE",
            "state": "MO",
            "postal_code": "64632",
            "telephone_number": "660-893-5750",
            "fax_number": "660-893-5751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 VICTORY LANE",
            "city": "CAINSVILLE",
            "state": "MO",
            "postal_code": "64632",
            "telephone_number": "660-893-5750",
            "fax_number": "660-893-5751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A",
        "authorized_official_last_name": "YOUNGER",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "816-232-6818"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "506065309",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cainsville Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cainsville Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cainsville, MO

Sources for this page

Verify at the official NPI Registry.