NPIMap

Organization Active NPI

West Side Community Health Services, Inc.

Doing business as Union Gospel Mission

  • Federally Qualified Health Center (FQHC)
  • Saint Paul, MN
National Provider Identifier
1104977255
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Doing business as
Union Gospel Mission
Practice address
435 University Ave E
Saint Paul, MN 55101-4437
Phone
(651) 290-6814
Fax
(651) 602-7580
NPI assigned
Jan 16, 2007
Last updated
Mar 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Authorized official

Name
Reuben Moore
Title
Ceo
Phone
(651) 602-7500

Specialties & licenses 1

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

Addresses

Primary practice location

435 University Ave E
Saint Paul, MN 55101-4437

Mailing address

153 Cesar Chavez St
Saint Paul, MN 55107-2226
Phone (651) 602-7500

Other names 1

  • Union Gospel Mission Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040209000647 MN Part B Supplier - Clinic/Group Practice 2062306434 Receives reassigned benefits from 116 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Paul, MN; Saint Paul Park, MN; Maplewood, MN; St. Paul, MN; Minneapolis, MN
O20061117000438 MN Part A Provider - Federally Qualified Health Center (FQHC) 2062306434 Practice locations: St Paul, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104977255. Details of each certification follow.

Federally qualified health center certification: CCN 241843

Legal name
WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 2, 2007
Last certification
Feb 2, 2007
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Dec 1, 1972 in MN
Enrollment address
435 University Ave
St Paul, MN 55101-4405

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory
Tax ID family
West Side Com HLTH SRVS22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Locations

735 University Ave W
Saint Paul, MN 55104

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Christine Singer Individual W-2 Managing EmployeeCoo May 29, 2015
Sheng Thao Individual Corporate Director Jan 1, 2009
Mary C Nesvig Individual W-2 Managing EmployeeCmo Oct 19, 1991
Peter Surdo Individual Corporate Director May 1, 2009
James B Warren Individual Corporate Director Aug 1, 2009
Blake Darsow Individual Corporate DirectorCfo Aug 26, 2016
W-2 Managing EmployeeCfo Aug 26, 2016
Hlee Lee Individual Corporate Director Aug 26, 2013
William Thompson Individual Corporate Director Jul 1, 2010
Reuben Moore Individual Corporate OfficerPresident and Executive Officer Oct 2, 2017
W-2 Managing EmployeeAd;Ceo Oct 2, 2017
Eric William Hanson Individual Corporate OfficerRevenue Data & Credentialing Manage Feb 28, 2022
W-2 Managing EmployeeRevenue Data & Credentialing MNGR Feb 28, 2022
Gladys Chuy Individual Corporate Officer Dec 17, 2015
Raul Noriega Individual Corporate OfficerVP of Revenue and It Sep 25, 2023
W-2 Managing EmployeeAd;VP of Revenue and It Sep 25, 2023
Andreatte E Hames Individual Corporate Director Aug 26, 2013
Mahogany Ellis-Crutchfield Individual Corporate Officer Nov 19, 2015

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
West Side Community Health Services, Inc.Saint Paul, MN, CCN 241804 Federally qualified health center Operational/Managerial Control Dec 8, 1988
Creative Arts ClinicSaint Paul, MN, CCN 241006 Federally qualified health center Operational/Managerial Control (100%) Nov 1, 2018

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740960000000",
    "number": "1104977255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 CESAR CHAVEZ ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551072226",
            "telephone_number": "651-602-7500",
            "fax_number": "651-602-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 UNIVERSITY AVE E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551014437",
            "telephone_number": "651-290-6814",
            "fax_number": "651-602-7580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST SIDE COMMUNITY HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "REUBEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "651-602-7500"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Union Gospel Mission",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.