NPIMap

West Side Community Health Services, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Saint Paul, MN

NPI 1104977255 · NPPES record last updated Mar 3, 2025

Key facts

NPI
1104977255
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Practice address
435 University Ave E
Saint Paul, MN 55101-4437
Phone
(651) 290-6814
Fax
(651) 602-7580
NPI assigned
Jan 16, 2007
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 1

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

Owned or controlled facilities with NPI records 2

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

Other NPIs on the same Medicare enrollment 17

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

Other NPIs with the same Medicare PAC ID 15

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

Corporate family (same tax ID) 21

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

Practitioners 53

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 53

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MN

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
Corporation · Non-profit
Incorporated
Dec 1, 1972 in MN
Enrollment address
435 University Ave
St Paul, MN 55101-4405

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 Employee
Coo		 May 29, 2015
Sheng Thao
Individual 		Corporate Director Jan 1, 2009
Mary C Nesvig
Individual 		W-2 Managing Employee
Cmo		 Oct 19, 1991
Peter Surdo
Individual 		Corporate Director May 1, 2009
James B Warren
Individual 		Corporate Director Aug 1, 2009
Blake Darsow
Individual 		Corporate Director
Cfo		 Aug 26, 2016
W-2 Managing Employee
Cfo		 Aug 26, 2016
Hlee Lee
Individual 		Corporate Director Aug 26, 2013
William Thompson
Individual 		Corporate Director Jul 1, 2010
Reuben Moore
Individual 		Corporate Officer
President and Executive Officer		 Oct 2, 2017
W-2 Managing Employee
Ad;Ceo		 Oct 2, 2017
Eric William Hanson
Individual 		Corporate Officer
Revenue Data & Credentialing Manage		 Feb 28, 2022
W-2 Managing Employee
Revenue Data & Credentialing MNGR		 Feb 28, 2022
Gladys Chuy
Individual 		Corporate Officer Dec 17, 2015
Raul Noriega
Individual 		Corporate Officer
VP of Revenue and It		 Sep 25, 2023
W-2 Managing Employee
Ad;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

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 Clinic
Saint Paul, MN · CCN 241006		 Federally qualified health center Operational/Managerial Control (100%) Nov 1, 2018

Medicare enrollment records

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

National Provider Directory

Tax ID family
WSHC-Homeless Center (22 organizations share this tax ID)

Locations

435 University Ave E
Saint Paul, MN 55130
Phone (651) 290-6814

735 University Ave W
Saint Paul, MN 55104

Specialties & licenses

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

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 identifiers

IdentifierTypeStateIssuer
106738OtherMNUCARE
076982000MedicaidMN

Other names

  • Union Gospel Mission Doing business as

Other providers in Saint Paul, MN

All providers in Saint Paul, MN · Federally Qualified Health Center (FQHC) in Minnesota

Sources for this page

Verify at the official NPI Registry.