NPIMap

Organization Active NPI

Affinia Healthcare

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
National Provider Identifier
1093723959
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
5008995962 Issued in MO
Legal business name
AFFINIA HEALTHCARE
Practice address
4414 N Florissant Ave
Saint Louis, MO 63107-1812
Phone
(314) 898-1700
Fax
(314) 898-1688
NPI assigned
Aug 4, 2006
Last updated
Sep 27, 2021By the provider in NPPES
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 5008995962 MO Primary

Addresses

Primary practice location

4414 N Florissant Ave
Saint Louis, MO 63107-1812

Mailing address

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

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
O20051018001046 MO Part A Provider - Federally Qualified Health Center (FQHC) 1052386919 Practice locations: Saint Louis, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093723959. Details of each certification follow.

Federally qualified health center certification: CCN 261895

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
Jul 13, 1964 in MO
Enrollment address
4414 N Florissant Ave
Saint Louis, MO 63107-1812

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 5

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

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

6763 Page Ave
Saint Louis, MO 63133
Phone (314) 206-3910

Ownership & related parties

All disclosed owners & managing parties 17

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, 2022
Riisa Rawlins Individual Corporate Officer Jan 1, 2022
Kevin Hachegechog Individual Corporate Officer Jan 1, 2018
Robert Jacobson Individual Corporate OfficerExecutive Committee Member of TH Jan 25, 2016
Debra Johns Individual Corporate Officer Jan 1, 2022
Kimball McMullin Individual Corporate Director Jan 25, 2016
Georgia Harris Individual Corporate Officer Jan 1, 2022
David Walters Individual Corporate Officer Jan 1, 2021
Jean M Frazee Individual Corporate OfficerTreasurer Jan 25, 2016
Laurel Tinsley Individual Corporate Officer Jan 1, 2021
Tondaleria Curry Individual Corporate Director Jan 25, 2016
Janet L Voss Individual Corporate OfficerVP/Cfo Apr 1, 2016 100%
Operational/Managerial ControlVP/Cfo Apr 1, 2016 100%
Mitchell L Baris Individual Corporate OfficerChairman of Board of Directors Jan 25, 2016
Carrollton Bank Organization, Clayton, MO Financial institution 5% Or Greater Mortgage Interest Mar 9, 2017 30.6%
Gwendolyn Hall Individual Corporate Director Jan 25, 2016
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 Director Jan 25, 2016

Practitioners & affiliated clinicians

Practitioners 6

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": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1093723959",
    "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": "4414 N FLORISSANT AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631071812",
            "telephone_number": "314-898-1700",
            "fax_number": "314-898-1688"
        }
    ],
    "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": "5008995962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.