NPIMap

Organization Active NPI

Health Partners of Western Ohio

Doing business as Mustang Health Center

  • Federally Qualified Health Center (FQHC)
  • Harrod, OH
National Provider Identifier
1124857131
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEALTH PARTNERS OF WESTERN OHIO
Doing business as
Mustang Health Center
Practice address
9105 Harding Hwy RM K129
Harrod, OH 45850-9485
Phone
(419) 224-4250
Fax
(419) 225-8878
NPI assigned
Jul 29, 2024
Last updated
Jul 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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

Authorized official

Name
Janis Sunderhaus
Title
Ceo
Phone
(419) 221-3072

Specialties & licenses 1

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

Addresses

Primary practice location

9105 Harding Hwy RM K129
Harrod, OH 45850-9485

Mailing address

329 N West St
Lima, OH 45801-4332
Phone (419) 221-3072

Other names 1

  • Mustang Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150313002043 OH Part B Supplier - Clinic/Group Practice 9436139987 Receives reassigned benefits from 153 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Toledo, OH; Tiffin, OH; New Carlisle, OH; Lima, OH; Bryan, OH; Defiance, OH; Harrod, OH; Holland, OH…
O20241022005084 OH Part A Provider - Federally Qualified Health Center (FQHC) 9436139987 Practice locations: Harrod, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124857131. Details of each certification follow.

Federally qualified health center certification: CCN D21053

Legal name
HEALTH PARTNERS OF WESTERN OHIO
Doing business as
MUSTANG HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 22, 2024
Last certification
Oct 22, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 18, 2002 in OH
Enrollment address
9105 Harding Hwy
RM K129
Harrod, OH 45850-9485

Other NPIs with the same Medicare PAC ID 21

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

View all 21

Other NPIs on the same Medicare enrollment 26

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

View all 26

National Provider Directory

National Provider Directory
Tax ID family
Allen County Health Par54 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Janis Sunderhaus Individual Corporate OfficerChief Executive Officer Jul 1, 2003
W-2 Managing EmployeeChief Executive Officer Jul 1, 2003
Operational/Managerial ControlChief Executive Officer Jul 1, 2003
Angel Cowan Individual Corporate DirectorBoard Member Nov 1, 2020
Kimberly Taflinger Individual Corporate OfficerCfo Jan 3, 2025
W-2 Managing EmployeeCfo Jan 3, 2025
Operational/Managerial Control Jan 3, 2025
Joseph a. Dake Individual Corporate DirectorBoard Member Aug 23, 2018
Lorna Simpson Individual Corporate DirectorBoard Member Jan 28, 2016
Arlisa Hall Individual Corporate DirectorBoard Member Jun 1, 2010
Anthony Lester Individual Corporate DirectorBoard Member Sep 1, 2011
John Stanovich Individual Corporate DirectorBoard Member Mar 1, 2014
Daisy Williamson Individual Corporate DirectorBoard Member Apr 1, 2024
Rebecca Dershem Individual Corporate DirectorBoard Member Oct 25, 2002
Mary Williamson Individual Corporate DirectorBoard Member Oct 1, 2002
William Stolly Individual Corporate DirectorBoard Member Sep 1, 2010

NPI Registry JSON

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

{
    "created_epoch": "1722211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1124857131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 N WEST ST",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458014332",
            "telephone_number": "419-221-3072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9105 HARDING HWY RM K129",
            "city": "HARROD",
            "state": "OH",
            "postal_code": "458509485",
            "telephone_number": "419-224-4250",
            "fax_number": "419-225-8878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH PARTNERS OF WESTERN OHIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-29",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A",
        "authorized_official_last_name": "SUNDERHAUS",
        "authorized_official_first_name": "JANIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-221-3072"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mustang Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harrod, OH

Sources for this page

Verify at the official NPI Registry.