NPIMap

Organization Active NPI

Northwest Health Services Inc

Doing business as Savannah Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Savannah, MO
National Provider Identifier
1104947126
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
Savannah Medical Clinic
Practice address
803 Highway 71 West
Savannah, MO 64485
Phone
(816) 324-3121
Fax
(816) 324-3122
NPI assigned
Apr 3, 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 NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

803 Highway 71 West
Savannah, MO 64485

Mailing address

803 Highway 71 West
Savannah, MO 64485-1151
Phone (816) 324-3121

Other identifiers 1

IdentifierTypeStateIssuer
500739511MedicaidMO

Other names 1

  • Savannah 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
O20031218000345 MO Part A Provider - Federally Qualified Health Center (FQHC) 7113835174 Practice locations: Savannah, 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 1104947126. Details of each certification follow.

Federally qualified health center certification: CCN 261870

Legal name
NORTHWEST HEALTH SERVICES INC
Doing business as
SAVANNAH MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 8, 2004
Last certification
Jan 8, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 1, 1983 in MO
Enrollment address
803 W US Highway 71
Savannah, MO 64485-1151

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
26D0444917Northwest Health Services Savannah Med Clinic803 Highway 71 West, Savannah, MO 64485Certificate of waiverJan 25, 2028

National Provider Directory

National Provider Directory

Locations

1303 State St
Mound City, MO 64470
Phone (660) 442-5464

503 S 6th St
Saint Joseph, MO 64501
Phone (816) 233-5188

803 W US Highway 71
Savannah, MO 64485
Phone (816) 324-3121

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
Denise K Jennings Individual Corporate OfficerBoard Vice President Mar 1, 2021
Jennifer McKinley Individual Corporate OfficerDirector Jun 1, 2019
Elizabeth Miller Individual W-2 Managing EmployeeRegional Clinic Manager Jul 28, 2025
Kevin Haywood Individual Corporate OfficerDirector Dec 1, 2021
Lanny Ellis Individual Corporate OfficerBoard Treasury Dec 1, 2021
Steve Loucks Individual Corporate DirectorBoard Member Jan 1, 2014 100%
Tona Williams Individual Corporate OfficerBoard President Mar 1, 2025
Sherry Weldon Individual Corporate OfficerBoard Secretary Jun 1, 2019
Tina R Taylor Individual Corporate OfficerCfo Mar 1, 2016 100%
W-2 Managing EmployeeInterim Cfo Mar 1, 2016 100%

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636502400000",
    "number": "1104947126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 HIGHWAY 71 WEST",
            "city": "SAVANNAH",
            "state": "MO",
            "postal_code": "644851151",
            "telephone_number": "816-324-3121",
            "fax_number": "816-324-3122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 HIGHWAY 71 WEST",
            "city": "SAVANNAH",
            "state": "MO",
            "postal_code": "64485",
            "telephone_number": "816-324-3121",
            "fax_number": "816-324-3122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "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": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500739511",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Savannah Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Savannah Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Savannah, MO

Sources for this page

Verify at the official NPI Registry.