NPIMap

Organization Active NPI

Samuel U. Rodgers Health Center, Inc.

Doing business as Samuel U. Rodgers Health Center Cabot Westside

  • Federally Qualified Health Center (FQHC)
  • Kansas City, MO
National Provider Identifier
1073950135
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SAMUEL U. RODGERS HEALTH CENTER, INC.
Doing business as
Samuel U. Rodgers Health Center Cabot Westside
Samuel U. Rodgers Health Center Cabot Westside Medical and Dental
Practice address
2121 Summit St
Kansas City, MO 64108-2126
Phone
(816) 471-0900
Fax
(816) 471-3150
NPI assigned
May 30, 2013
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Hilda Fuentes, MPA
Title
Chief Executive Officer
Phone
(816) 889-4600

Specialties & licenses 1

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

Addresses

Primary practice location

2121 Summit St
Kansas City, MO 64108-2126

Mailing address

825 Euclid Ave
Kansas City, MO 64124-2323
Phone (816) 474-4920

Other identifiers 1

IdentifierTypeStateIssuer
1073950135MedicaidMO

Other names 2

  • Samuel U. Rodgers Health Center Cabot Westside Doing business as
  • Samuel U. Rodgers Health Center Cabot Westside Medical and Dental Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031105000813 MO Part B Supplier - Clinic/Group Practice 9739092826 Receives reassigned benefits from 81 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Blue Springs, MO; Kansas City, MO; Liberty, MO
O20131210000382 MO Part A Provider - Federally Qualified Health Center (FQHC) 9739092826 Practice locations: Kansas City, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073950135. Details of each certification follow.

Federally qualified health center certification: CCN 261065

Legal name
SAMUEL U RODGERS HEALTH CENTER INC
Doing business as
SAMUEL U RODGERS HEALTH CENTER CABOT WESTSIDE MEDICAL AND DENTAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 11, 2013
Last certification
Dec 11, 2013
Ownership / control type
For profit – partnership
Organization structure
OtherNon-profit
Enrollment address
2121 Summit St
Kansas City, MO 64108-2126

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Tax ID family
Samuel U Rodgers Commun11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

825 Euclid Ave
Kansas City, MO 64124
Phone (816) 889-4816

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Monique Jones Individual W-2 Managing EmployeeCredentialing Co-Ordinator May 28, 2018
Robert Theis Individual 5% Or Greater Indirect Ownership InterestActing Ceo and Coo Feb 2, 2009 5%
Corporate OfficerActing Ceo and Coo Nov 20, 2006
Christopher Walker Individual Corporate OfficerChief Financial Officer Oct 9, 2017
Elizabeth Bordenave Individual Corporate Officer Jan 1, 2024

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1369872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1073950135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 EUCLID AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641242323",
            "telephone_number": "816-474-4920",
            "fax_number": "816-889-1845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 SUMMIT ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641082126",
            "telephone_number": "816-471-0900",
            "fax_number": "816-471-3150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL U. RODGERS HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-30",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "FUENTES",
        "authorized_official_first_name": "HILDA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "816-889-4600",
        "authorized_official_credential": "MPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073950135",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samuel U. Rodgers Health Center Cabot Westside",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Samuel U. Rodgers Health Center Cabot Westside Medical and Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.