NPIMap

Organization Active NPI

Samuel U. Rodgers Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Kansas City, MO
National Provider Identifier
1114236189
Registry record updated Jun 11, 2019
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.
Practice address
6400 E 23Rd St
Kansas City, MO 64129
Phone
(816) 231-5746
Fax
(816) 889-1849
NPI assigned
Sep 24, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Robert Theis
Title
Acting Ceo
Phone
(816) 474-4920

Specialties & licenses 1

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

Addresses

Primary practice location

6400 E 23Rd St
Kansas City, MO 64129

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
500859111MedicaidMO

Other names 2

  • Samuel U Rodgers Health Center J A Rogers Family Dental Doing business as
  • Samuel U. Rodgers Health Center JA Rogers Family Dental Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

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

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

Locations

6400 E 23rd St
Kansas City, MO 64129
Phone (816) 418-3677

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1285286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1114236189",
    "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": "6400 E 23RD ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "64129",
            "telephone_number": "816-231-5746",
            "fax_number": "816-889-1849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL U. RODGERS HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-24",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "THEIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "ACTING CEO",
        "authorized_official_telephone_number": "816-474-4920"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500859111",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samuel U Rodgers Health Center J A Rogers Family Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Samuel U. Rodgers Health Center JA Rogers Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kansas City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.