NPIMap

Organization Active NPI

Samuel U. Rodgers Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Kansas City, MO
National Provider Identifier
1194216259
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
3701 N Jackson Ave
Kansas City, MO 64117
Phone
(816) 321-5053
NPI assigned
May 24, 2018
Last updated
Jun 11, 2019By the provider in NPPES
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

3701 N Jackson Ave
Kansas City, MO 64117

Mailing address

825 Euclid Ave # Q112764
Kansas City, MO 64124-2323
Phone (816) 474-4920

Other names 1

  • Samuel U. Rodgers Health Center Chouteau Elementary Other name

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194216259. Details of each certification follow.

  • CCN 261159 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 261159

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SAMUEL U RODGERS HEALTH CENTER CHOUTEAU ELEMENTARY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 1, 2018
Last certification
Aug 1, 2018
Ownership / control type
For profit – corporation
Facility address
3701 N Jackson Ave
Kansas City, MO 64117

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

3701 N Jackson Ave
Kansas City, MO 64117
Phone (816) 321-5053

NPI Registry JSON

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

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1194216259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 EUCLID AVE # Q112764",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641242323",
            "telephone_number": "816-474-4920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 N JACKSON AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "64117",
            "telephone_number": "816-321-5053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL U. RODGERS HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-24",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samuel U. Rodgers Health Center Chouteau Elementary",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Samuel U. Rodgers Health Center Chouteau Elementary",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.