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Northwest Health Services Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Saint Joseph, MO

NPI 1194846550 · NPPES record last updated Nov 10, 2021

Key facts

NPI
1194846550
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
NORTHWEST HEALTH SERVICES INC
Practice address
5001 Lake Ave
Saint Joseph, MO 64504-1170
Phone
(816) 238-7788
Fax
(816) 238-9285
NPI assigned
Apr 3, 2007
Organization subpart
No

Authorized official

Name
Matt Younger
Title
Ceo
Phone
(816) 232-6818

Other NPIs on the same Medicare enrollment 16

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

Other NPIs with the same Medicare PAC ID 14

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

Practitioners 21

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

Medicare participation

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

Federally qualified health center certification: CCN 261875

Legal name
NORTHWEST HEALTH SERVICES INC
Doing business as
SOUTH SIDE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 7, 2004
Last certification
May 7, 2004
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
May 1, 1983 in MO
Enrollment address
5001 Lake Ave
Saint Joseph, MO 64504-1170

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Kimberly Ireland
Individual 		Corporate Director
Board of Directors Vice President		 Mar 2, 2010 100%
Whitney Lanning
Individual 		Corporate Director
Board of Directors President		 Jan 1, 2020 100%
Steve Loucks
Individual 		Corporate Director
Board Member		 Jan 1, 2014 100%
Tina R Taylor
Individual 		Corporate Director
Interim Cfo		 Mar 1, 2016 100%
W-2 Managing Employee
Interim Cfo		 Mar 1, 2016 100%
Robin Moppin
Individual 		W-2 Managing Employee
Billing & Coding Manager		 Feb 1, 2020 100%
Operational/Managerial Control
Billing & Coding Manager		 Feb 1, 2020 100%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040421001394 MO Part a Provider - Federally Qualified Health Center (FQHC) 7113835174 Practice locations: Saint Joseph, MO
O20040720001347 MO Part B Supplier - Clinic/Group Practice 7113835174 Receives reassigned benefits from 24 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gower, MO; Savannah, MO; Saint Joseph, MO; King City, MO; Hamilton, MO; Braymer, MO; Chillicothe, MO; Cainsville, MO…

National Provider Directory

Locations

305 Rhode Island St
King City, MO 64463
Phone (660) 535-4347

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

5001 Lake Ave
Saint Joseph, MO 64504-1170

Mailing address

5001 Lake Ave
Saint Joseph, MO 64504-1170
Phone (816) 238-7788

Other identifiers

IdentifierTypeStateIssuer
509384202MedicaidMO

Other names

  • South Side Health Center Doing business as

Other providers in Saint Joseph, MO

All providers in Saint Joseph, MO · Federally Qualified Health Center (FQHC) in Missouri

Sources for this page

Verify at the official NPI Registry.